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“It’s like quicksand”: Contrasting time-based quality metrics and experience diagnosing and treating sepsis among U.S. Department of Veterans Affairs Clinicians
Journal article   Open access   Peer reviewed

“It’s like quicksand”: Contrasting time-based quality metrics and experience diagnosing and treating sepsis among U.S. Department of Veterans Affairs Clinicians

Jennifer Van Tiem, Elissa Z. Faro, Julia E. Friberg Walhof, Mary Good, James Blum and Heather Schacht Reisinger
SSM - health systems, Vol.6, 100227
06/2026
DOI: 10.1016/j.ssmhs.2026.100227
url
https://doi.org/10.1016/j.ssmhs.2026.100227View
Published (Version of record) Open Access

Abstract

Four ethnographic site visits were conducted at two lower and two higher performing United States Department of Veterans Affairs (VA) hospitals based on their observed-to-expected hospital mortality among sepsis patients. The objective was to examine local contextual factors such as protocols and clinical workflows that shaped sepsis care at hospitals. Physicians, nurses, and quality improvement staff at both low and high performing hospitals described sepsis similarly as nonspecific and common. They also both described challenges with transitions in care primarily from ED to ICU, getting medications to patients in a timely manner, and identifying time zero for the multiple time-based quality metrics specific to sepsis performance improvement initiatives. The difference came in the utilization of tele-critical care (CC) support. High performing sites were more likely to integrate tele-CC in their routine care of septic patients and their review of sepsis quality metrics. Time-based metrics that are central to sepsis performance improvement programs do not reflect clinician experience identifying and treating sepsis. Team-based care that allowed for real-time interactions with experienced clinicians and performance improvement support may be a critical component to improving sepsis outcomes. •Both high and low performing sites conceptualize sepsis similarly.•Time-based metrics do not reflect clinicians’ experience with sepsis.•Real-time support and feedback interventions needed to improve sepsis metrics.
 Critical Care Telemedicine Evaluation Implementation Measurement Performance improvement Sepsis

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