Here is the standardised PICO analysis for the twenty-first uploaded article:
Full Title
Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway
Authors: Asma M. Ahmed, Efy Macapili, Michael J. Brenner, Vinciya Pandian
Journal: Journal of Nursing Care Quality, 2024; 39(1):67–75
DOI: 10.1097/NCQ.0000000000000729
Type of Study
Pre/post-intervention quality improvement study in one U.S. skilled nursing facility (SNF)
PICO Summary
Population (P)
- Residents of a 99-bed skilled nursing facility (SNF) in the western United States
- Predominantly older adults (mean age ~77 years), 72% female
- Common comorbidities included dementia, heart failure, COPD, diabetes, cerebrovascular disease
- Sample size: 178 residents (81 pre-implementation; 97 post-implementation)
Intervention (I)
- Modified SNF sepsis care pathway, incorporating:
- Sepsis screening tool based on SIRS criteria
- Risk factor documentation
- SBAR communication (Situation, Background, Assessment, Recommendation)
- Physician-initiated sepsis bundle (labs, imaging, early antibiotics and IV fluids)
- Staff training (nurses, CNAs, physicians) included 20-minute educational sessions, print materials, posters, and just-in-time feedback
Comparison (C)
- Pre-implementation care with no standardised sepsis protocol
- Comparison between outcomes before and after pathway implementation
Outcomes (O)
Process outcomes:
- Sepsis recognition improved significantly from 56% to 86% (P < .001)
- SBAR use and physician notification compliance reached 100% post-intervention
- Sepsis bundle orders increased (44% of eligible cases vs 0% pre-intervention)
- Use of screening tests (e.g., lactate, WBC, cultures) rose significantly
Clinical outcomes:
- Hospital transfers for sepsis decreased from 68% to 44.4% (not statistically significant, P = .07)
- Median SNF length of stay increased from 4 to 6.5 days (P = .01), attributed partly to more on-site management and higher COVID-19 prevalence
- Mortality rates declined from 28% to 13.9% (not statistically significant)
- Mortality associated with having >4 comorbidities (P = .009)
- COVID-19 prevalence higher in post-implementation group (60.4% vs 22.4%)
Findings Summary
Implementing a tailored sepsis pathway in an SNF led to improved early recognition, documentation, and clinical response to suspected sepsis. Although not all clinical outcomes (mortality, hospitalisation) reached statistical significance, reductions in transfers and improvements in care processes suggest promise for reducing sepsis-related harm in long-term care settings. The study occurred during the COVID-19 pandemic, which may have confounded outcomes and limited generalisability .
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