Improving Sepsis Bundle Compliance in the Emergency Department Through In Situ Simulation

Sepsis, severe sepsis, and septic shock remain leading causes of morbidity and mortality in the emergency department. Early recognition and timely management improve outcomes; however, adherence to Centers for Medicare and Medicaid Services sepsis bundle guidelines remains inconsistent, often due to limited familiarity with clinical order sets and difficulty recognizing sepsis severity in real time. Prior initiatives improved knowledge but rarely integrated team-based, order set–focused simulation to address workflow barriers. This study aimed to evaluate whether in situ simulation using the electronic medical record improves provider knowledge and confidence related to sepsis bundle implementation.

We conducted a prospective, multidisciplinary, in situ simulation study in a tertiary care emergency department. Emergency department providers, including residents, nurses, and attendings, were recruited via convenience sampling. Participants completed two high-fidelity scenarios differentiating sepsis vs septic shock using Epic Playground, a simulated electronic medical record, to navigate and place sepsis orders. Pre- and post-intervention assessments included a four-item multiple-choice, knowledge-based instrument and four self-reported confidence items measured using Likert scales, assessing comfort with order sets, recognition of sepsis severity, and confidence initiating guideline-concordant care. Scenarios were followed by structured debriefs highlighting missed bundle components and workflow strategies. Paired pre- and post-intervention results were compared using the Wilcoxon signed-rank test.

Twenty-two participants were included in the analysis. Knowledge scores increased from a mean of 2.91 (SD 0.92) to 3.23 (SD 0.69) (p = 0.053). Likert-scale scores demonstrated significant improvements across all confidence-based measures (p < 0.05 for all).

Integrating team-based, electronic medical record–focused simulation was associated with improved knowledge and confidence related to sepsis bundle implementation and may support real-world emergency department workflows. Findings may be generalizable to similar academic emergency department settings but are limited by single-center design and sample size.