BMJ  2008;336:440-443 (23 February), doi:10.1136/bmj.39454.634502.80

Practice

Quality Improvement Report

Improving early management of bloodstream infection: a quality improvement project

¹ Infection and Travel Medicine, St James’s University Hospital, Leeds LS9 7TF, ² Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX

The first 150 words of the full text of this article appear below.

Abstract Problem Bloodstream infection is a common but serious illness with high mortality and morbidity, which is seen in many clinical specialties. Errors such as delay in diagnosis and lack of effective treatment often occur. Design Initial observational study followed by prospective study before and after intervention in a high risk clinical area. Setting 1400 bed teaching hospital in the United Kingdom where the initial management of all inpatients with bloodstream infections was surveyed over six weeks. This showed 55 major errors in 46 (30%) of 157 episodes of bloodstream infection. Most (44) were in general areas of the hospital without a specific protocol for managing sepsis. 29 of the 55 errors were caused by delay in giving effective antibiotics to critically ill patients. In 19 cases, effective antibiotics were still not given despite advice from infection services based on blood culture results. A diagnosis of bloodstream infection had not been . . . [Full text of this article]

Outline of problem

Box 1 Criteria for major errors

Key measures for improvement

Process of gathering information

Analysis and interpretation

Strategy for change

Box 2 Strategy for improving early management of bloodstream infections
Guidelines for recognition of severe sepsis
Guidelines for management of severe sepsis
Bacteraemia service

Effects of change

Lessons learnt and next steps

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This article has been cited by other articles:

• Butt, M. A, Coulson, A K, Hull, J H, Ho, T B L (2008). Early treatment strategies in sepsis. BMJ 336: 521-521 [Full text]  
• Barlow, G. D, Lillie, P. (2008). Bacteraemia service model of infection care. BMJ 336: 521-521 [Full text]  

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