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Quality Improvement Seminar Series leads to clinical improvements for diagnosis of sepsis at rural health facilities

Quality Improvement is a key priority across Nova Scotia Health. Sharing evidence-based practice is valuable to clinicians across the province and promoting discourse that includes their clinical realities is the catalyst to making changes that improve outcomes for all.

From April 20 to June 1, 2022, Nova Scotia Health, in partnership with Doctors Nova Scotia and Dalhousie Continuing Medical Education, hosted the inaugural semester of Quality Improvement Rounds for physicians. These sessions were developed for, and delivered by, physicians, in order to promotes best practices and to share results of quality review projects directed at improving treatment and health outcomes for common issues contributing to patient morbidity and mortality.

“We were receiving these excellent quality reviews through our medical advisory table. The recommendations included getting these findings out to the front lines, and I felt that this presented an opportunity to better connect physicians with our quality team and provide improved value for all,” said Dr. Nicole Boutilier, Vice President of Medicine at Nova Scotia Health. “We partnered with Doctors Nova Scotia because they had the platform that was well tested through COVID-19, and with Dalhousie so attendees could get learning credits for participation.”

The sessions were targeted toward physicians who provide inpatient and emergency department care. More than 160 Nova Scotian physicians participated in the sessions.

Dr. Sarah McMullen, Critical Care Physician at Nova Scotia Health, presented a session on evidence-based practice updates that promote earlier recognition of sepsis and septic shock, thus leading to better patient care outcomes. In her session, she discussed the vital importance of early diagnosis of sepsis/septic shocks, supported by key laboratory investigations like elevation in serum lactate, as part of the (arterial or venous) blood gas panel that makes up routine bloodwork for these conditions.   

Sepsis and septic shock are life-threatening responses to infection. Any physician can diagnose sepsis and septic shock, based on constellations of physical findings such as fever (or hypothermia), low blood pressure, increased heart rate, and difficulty breathing or mentating, for example. However, the patient’s serum lactate levels provide crucial insight into the true severity of illness, when these signs are present in the context of an infection - allowing physicians to give targeted treatment like early broad-spectrum antibiotics and intravenous fluids, maintaining delivery of oxygen to tissues and vital organs. The earlier and more aggressively treatment is provided, the better the likelihood of recovery. 

During the session, Dr. Lisa Bonang, Site Lead of the Tri-facilities in the Eastern Shore (Twin Oaks Memorial, Eastern Shore Memorial, Musquodoboit Valley Memorial and Hants Community Hospital), expressed that her sites did not have the required cartridges for point of care lactate tests.

As a follow up to the session, senior director of Quality Improvement and Safety at Nova Scotia Health, Gail Blackmore, began work to improve access to this crucial lab test for rural facilities. At the Tri-facilities, initial feedback from the health care staff has been positive.

“The providers at the Tri-Facilities are very pleased that the leadership at Nova Scotia Health heard the feedback during the sepsis presentation. We strive to provide the best care possible, based on the latest guidelines and standards of care,” said Bonang. “The positive action by Nova Scotia Health to facilitate the addition of lactate to our point-of-care testing means that we can efficiently diagnose sepsis and take immediate action. This will improve patient care and improves satisfaction among our providers.”

Roberta Duchesne, Director of Community and Rural Sites at the Tri-facilities and Hants Community, agreed with Dr. Bonang.

“This is an exciting initiative for our team that will enhance our ability to provide support to our community,” said Duchesne.

Conversations with physicians are crucial to understanding how Nova Scotia Health can support health care in providing the best and most effective care. Nova Scotia Health is looking forward to continuing the Quality Improvement Rounds this Fall and into the future.

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