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Understanding Sepsis Bundle Compliance Perceptions using Dimensional Representation of Survey Responses from Frontline Care Providers

Mark Cohen, Inki Kim, James Rehg, Charlie Hawknuff, Carlos Brown, Shandra Jamison, Angelia Deweese, Mae Vogel, Debapriya Dutta, Linda Owens, Emily Wee,Cassie Cox, Staci Hoffman

The quality measures (SEP-1) for compliance with a standardized "bundled" treatment protocol vary widely across hospitals although adherence to bundles is known to improve patient outcomes. The variation in bundle compliance implies the interdependence of a broad array of positive and negative factors associated with patient conditions, clinician competencies, care process and teamwork, and environment. We have a limited understanding of the true complexity behind bundle compliance (or non-compliance) in clinical practice. This article thus aimed to understand frontline care providers’ perceptions associated with sepsis bundle compliance at an acute care hospital in the Midwest. We surveyed 68 clinicians (of nurses and physicians from emergency department) about their perceived difficulties, educational gaps, and confidence with sepsis knowledge, along with sepsis-related education and experience. The survey responses were encoded to a data matrix and transformed using the mathematics of Singular Value Decomposition (SVD) to build a dimensional representation, dubbed “perceptual space”, of collective perceptions surrounding bundle compliance. Two principal dimensions comprising the perceptual space were identified, the first distinguishing “all-or-nothing” versus multifaceted, analytical reasoning for recognition, and the second splitting between system-wide versus case-specific foci for intervention. Both dimensions explained the majority (65.5%) of the total variability in the input data matrix. Additionally, statistical tests revealed that clinicians’ experience with sepsis, level of medical education, and clinical role had significant relationships with perceptions. The proposed representation method has potential for guiding compliance-enhancing strategies in a prospective manner, as opposed to the current quality measures (SEP-1), which is retrospective and outcome-driven.