Institute for Healthcare Improvement: Setting Aims

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Setting Aims

The first step in improving the care of patients with severe sepsis and septic shock is making a solid commitment to improving that care. This commitment includes a strong and well-worded aim statement that sets an aggressive global aim. It is critical that the overall aim has a measurable objective and a specified time frame.

The aim of the Surviving Sepsis Campaign is "a 25 percent reduction in sepsis mortality within the next 5 years (2009)" [Dellinger RP, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Critical Care Medicine. 2004;32(3):858-873].

In addition to the global aim, the sepsis work is divided into segments, each having its own specific aim, all of which contribute to achieving the global aim.

Each institution committed to this aim should have senior leaders involved in setting the specific aims, to ensure that these aims are aligned with the organization's strategic goals. When senior leaders approve the aims, they should also make a commitment to giving the team whatever support is needed to achieve them.

The following are specific aims, adopted from the Surviving Sepsis Campaign guidelines, that support the global aim of improving septic patient mortality. These aims break the work into smaller, measurable, achievable chunks for teams to tackle. Several teams may be working on specific aims simultaneously, with all reporting to the leadership team.

Examples of Effective Aim Statements


	Time from ED admission to presumptive diagnosis of severe sepsis is less than 2 hours Time from ED admission to all patients meeting severe sepsis criteria having a serum lactate is less than 4 hours Time from ED admission to appropriate antibiotics given is less than 4 hours If hypotensive or if lactate greater than 4.0 mmol, immediate fluid resuscitation is started (at least 30 ml/kg normal saline or lactated ringers solution within one hour) If mean arterial blood pressure is less than 65 mmHg and not responsive to adequate (at least 30 ml/kg) fluid resuscitation, vasopressors are started immediately If blood pressure or serum lactate not responsive to fluid, a central venous pressure monitor is instituted within the first 4 hours Inotropes and/or packed red blood cells (when appropriate for hematocrit less than 30) are used if superior vena cava hemoglobin saturation is less than 70% following adequate (at least 30 ml/kg) fluid resuscitation From ED admission time, glucose is controlled to <150 mg/dl greater than 80% of the time for a period between 4-24 hours From ED admission time, ventilated patients have plateau pressures less than 30cm H20 greater than 80% of the time for a period between 4-24 hours Low-dose steroids are given for persistent hypotension or if still requiring vasopressors after 4 hours from the time the CVP is greater than 8-10 cm H2O pressure



How to Improve Forming the Team Establishing Measures Selecting Changes Testing Changes Enhancing Reliability