Practice Quality Improvement Report

Improving early management of bloodstream infection: a quality improvement project

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39454.634502.80 (Published 21 February 2008) Cite this as: BMJ 2008;336:440
  1. Jane Minton, consultant in infectious diseases1,
  2. James Clayton, specialist registrar in medical microbiology2,
  3. Jonathan Sandoe, consultant microbiologist2,
  4. Hugh Mc Gann, consultant in infectious diseases1,
  5. Mark Wilcox, professor of medical microbiology2
  1. 1Infection and Travel Medicine, St James’s University Hospital, Leeds LS9 7TF
  2. 2Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX
  1. Correspondence to: J Minton jane.minton{at}leedsth.nhs.uk
  • Accepted 15 November 2007

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 considered in 7 patients already in hospital despite clear signs of sepsis for more than 48 hours.

  • Strategy for improvement Development of guidelines for recognition and initial management of patients with severe sepsis and bloodstream infection, implementation of an education programme on clinical standards for managing sepsis, and introduction of a bacteraemia service that included feedback.

  • Key measure of improvement Reduction in incidence of major errors in early management of bloodstream infection.

  • Effects of change In the second part of the study, major errors were found in 11 of 37 episodes (30%) immediately before the intervention in the main high risk area (medical wards), whereas such errors were found in 6 of 79 episodes (8%) after the intervention.

  • Lessons learnt The early management of patients with bloodstream infection was often suboptimal. The underlying factors included failure to recognise patients with serious infection; delays in giving antibiotics as a result of …

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