Improving Sepsis Bundle Compliance Through a Multimodal Telemedicine Intervention

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 11

AP

Ashok Palagiri, MD

Mercy Virtual Care, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.
LJ

Loretta James, RN

Sepsis Liaison
Mercy Hospital St Louis

Disclosure information not submitted.
RE

Rita English, RN

Senior Clinical Quality Measure Specialist
Mercy Hospital St Louis

Disclosure information not submitted.
RS

Richard Schmidt, MD

Emergency Medicine Department Chairman
Mercy Hospital Saint Louis

Disclosure information not submitted.
TD

Trisha Dorries, MBA

Senior Quality Improvement Specialist
Mercy Hospital St Louis

Disclosure information not submitted.
SG

Sarah Gastman, RN

Quality Management-Director
Mercy Hospital St Louis

Disclosure information not submitted.
JP

Jen Pipkin, RN

EDON
Mercy Hospital St Louis

Disclosure information not submitted.
MM

Mary McCoy, RN

Neuro-Trauma ICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
SS

Stefanie Struckhoff, RN

MSICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
PL

Patrick Luecke, RN

CVICU Manager
Mercy Hospital St Louis

Disclosure information not submitted.
RD

Rachel Dutton, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
EG

Elizabeth Glidewell, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
kK

kelsey Kyle, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
JH

Jacob Hahn, RN

RN
Mercy Hospital St Louis

Disclosure information not submitted.
CA

Carly Augsburger, PharmD

PharmD
Mercy Hospital St Louis

Disclosure information not submitted.
JP

John Ponzillo, PharmD

PharmD
Mercy Hospital St Louis

Disclosure information not submitted.
AK

Anup Katyal, MD

Mercy Hospital Saint Louis

Disclosure information not submitted.
WM

Walter Mickey, DO

Saint Johns Mercy Hospital

Disclosure information not submitted.
Vinaya R. Sermadevi, MD (she/her/hers)

Mercy Hospital Saint Louis, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.
FS

Farid Sadaka, MD

Mercy Heart and Vascular Hospital St. Louis, Missouri

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Sepsis and septic shock are time-critical conditions with high morbidity and mortality, particularly in intensive care units (ICUs) and emergency departments (EDs). Early recognition and rapid initiation of guideline-based therapies are essential to improving outcomes. Adherence to sepsis bundles remains variable due to delays in recognition, and gaps in workflow execution. This QI project aimed to enhance compliance with four core sepsis bundle components: (1) lactate measurement within 3 hours (LA), (2) blood culture collection before antibiotic administration (BC), (3) administration of broad-spectrum antibiotics (AX), and (4) timely intravenous fluid resuscitation (30 cc/kg, IVF).

Methods: This QI study compared compliance data before (CY 2023) and after (CY 2024) implementation of a bundled sepsis intervention that incorporated the following components: Telemedicine support: A virtual registered nurse (vRN) identified ICU patients with potential sepsis or septic shock and used secure EPIC chat to alert bedside physicians and nurses of outstanding bundle elements; Clinical decision support: Bedside physicians placed required sepsis orders or documented reasons for non-compliance, assisted by the vRN, who also scribed notes in EPIC; Early ED sepsis identification: ED patients suspected of having sepsis were pre-admitted in EPIC before being assigned a room, allowing for earlier activation of the bundle; Ongoing support and education: ICU, ED, nursing, and pharmacy leaders participated in implementation and monthly case reviews with provider feedback, and developed an online sepsis education module.

Results: A total of 200 patients were evaluated in CY 2023 (pre-intervention) and 400 in CY 2024 (post-intervention). Compliance with individual sepsis bundle components significantly improved post-intervention: LA from 84% to 97% (p = 0.001), AX from 39% to 96% (p = 0.001), and BC from 61% to 94% (p = 0.001), while IVF compliance was similar (92 % vs 88 %). All-bundle compliance improved from 47% to 78% (p = 0.0001).

Conclusions: A telemedicine-driven, multidisciplinary intervention combined with early ED identification significantly improved compliance with sepsis bundle components. This approach highlights a scalable, system-level strategy to improve timely sepsis care delivery.