Research Articles from the SHS-UHN ASP (Category)

SNAP—Sepsis Now A Priority: Development and Implementation of a Sepsis Algorithm in the Emergency Department of an Academic Hospital

S West
C McDonald
D Dushenski
K Van Den Broek
S Lapinsky
M Morgan
A Morris



Objectives:  We developed a sepsis algorithm based on the results of a chart audit of 364 patients presenting to the ER at Mount Sinai Hospital (MSH) in Toronto, Canada, with sepsis in 2010-11.  Our algorithm was aimed at improving sepsis management and outcomes by identifying patients early and providing them with rapid, protocolized care in the MSH emergency department (ED).

Methods:  The prior chart audit was the basis for the development of the Sepsis Now A Priority (SNAP) Recognition and Management algorithm, identifying gaps or deficiencies in care to be addressed.  The practice changes implemented were:  1) employment of the SNAP algorithm into the ED with aggressive timelines for clinicians; 2) pre-printed order sets for initial and ongoing management of sepsis; 3) linking patient-tracking board data with collection reports; 4) revised electronic order set for sepsis symptoms; and 5) revised nursing medical directives that align with the algorithm.

Results:  The SNAP algorithm was implemented on July 21st, 2014.  As of January 1st, 2015, there were 378 patients entered into the algorithm at triage.  An initial chart audit of 30 patients entered into the algorithm demonstrated that 53% (16/30) of patients had a diagnosis of sepsis.  Of those, 19% (3/16) had severe sepsis and 6% (1/16) had septic shock.  Data collected to date has demonstrated that the timelines of the algorithm are being met and that septic patients are being flagged and treated swiftly.  Ongoing post-implementation review will evaluate patient outcomes including mortality, morbidity, length of stay and process measures (i.e. time to diagnosis, time to appropriate fluid resuscitation, antibiotics, etc.).

Conclusion:  The ability to recognize sepsis early is essential to improving outcomes.  The intent of the SNAP algorithm is to allow for early recognition of septic patients, with rapid, protocolized care.  By implementing this concise quality improvement tool to optimize diagnosis and treatment, we hope to improve outcomes for patients with sepsis.  Our algorithm prioritizes identifying patients with possible sepsis over having a specific tool, which would identify fewer patients who do not end up having sepsis.