Grant: Operating Grant: Knowledge to Action

Title: Development and evaluation of a context-appropriate evidence-based clinical algorithm to improve sepsis outcomes in the Tikur Anbessa Emergency Department

<html> <body> <p>Healthcare systems globally fail to optimally use evidence to improve clinical care and patient outcomes. Evidence-based clinical algorithms (EBCA), improve uptake of evidence into practice by codifying evidence into rules or action plans to facilitate efficient delivery of appropriate evidence-based care. However, most EBCAs are developed in high income countries, (HICs) limiting their applicability to healthcare settings in low and middle income countries (LMICs).</p> <p> <br>An estimated 30 million sepsis cases occur globally per year, with higher rates in LMICs. Mortality remains high at 10-50% globally, with only 10-30% of patients receiving optimal care. This care gap is due in part to the intense resource demands of early sepsis treatment guidelines, challenging even in HICs. However, recent studies have found that lower resource interventions, namely early recognition, and aggressive antibiotic and supportive care, are equally effective to higher resource interventions.</p> <p> <br>The Tikur Anbessa Hospital (TASH) is the largest publically-funded academic and referral hospital in Ethiopia and a leader in the development of emergency medicine. It has an annual emergency department (ED) census of 18,000, with 20-25% of patients critically ill at presentation, and 2-3 septic patients managed daily. Our recent study found 19% of patients who died within 72 hours of presentation to the TASH-ED died from sepsis and that most patients did not receive timely, evidence-based care.</p> <p> <br> <u>Objectives</u> </p> <p> <br>1. To reduce sepsis mortality by implementing and evaluating a context-appropriate sepsis EBCA in the TASH-ED.<br>2. To identify barriers and facilitators to sustainability and scalability of the sepsis strategy to other Ethiopian hospitals and assess its potential to address gaps in other areas of care.</p> <p> <br> <u>Methods:</u> </p> <p> <br>Our team includes emergency medicine experts and KT researchers, who have worked together since 2008, developed and implemented the first emergency medicine residency training program in Ethiopia, and completed several studies in the TASH-ED including 2 preparatory studies.</p> <p> <br>This project will employ a mixed methods design. We will conduct an interrupted times series (ITS) study to evaluate the effectiveness of a KT strategy in improving care and reducing sepsis mortality (objective 1).<br> <br>A process evaluation employing qualitative methods including key informant interviews, and document review of staff and working group meeting notes, will be completed to assess barriers/facilitators to scalability, sustainability, and to assess the potential of the approach to address other common high burden clinical presentations in the TASH-ED (objective 2).<br> <br> <u>Significance</u> <br> <br>This project aims to address an identified gap in sepsis care in the TASH-ED.<br> <br>The results will strengthen the Ethiopian health system by:<br> <br>1. Addressing an identified gap in sepsis care by developing a sustainable KT strategy to improve sepsis care and reduce mortality in the TASH-ED.<br> <br>2. Directly informing efforts of Knowledge Users to develop a national sepsis protocol and EBCAs for other high burden ED presentations. The results of this study will also be useful to other LMICs as appropriate sepsis care is a global challenge.<br> </p> </body> </html>

Straus, Sharon E; Debebe, Finot; Demisse, Lemlem; Hamid, Jemila; Hunchak, Cheryl L; Landes, Megan; Puchalski Ritchie, Lisa M; Tumebo, Aklilu; Woldetsadik, Assefu