September is Sepsis Awareness Month: Dr. Tania Sullivan is looking beyond education to improve sepsis care

In healthcare, well-written policies are essential. But as thorough as they might be, they aren’t effective when they’re not practical.

That’s at the heart of work Dr. Tania Sullivan and her team are doing with early identification and treatment of sepsis.

“Everybody wants to show up to work and recognize sepsis,” Sullivan said.  

The question, she points out, is whether healthcare systems are making it as easy as possible for clinicians to do that.

One example is NEWS2, the National Early Warning Score 2, a tool that uses routinely collected vital signs to help healthcare teams recognize when a patient’s condition may be deteriorating. Changes in a patient’s score can prompt closer monitoring or escalation of care and may help identify patients with previously unrecognized sepsis.

“We have policies that we adopt because they’ve been shown to improve outcomes for patients,” Sullivan said. “But what are the factors that potentially prevent translating this policy and all its scientific benefit to the level of the patient?”

Sepsis can develop quickly, making early recognition and response critical. Sepsis was identified by Nova Scotia Health as a priority area for significant and sustained improvement. Advancing this priority requires more than building awareness. It also means creating systems that support timely recognition and action.

For Sullivan, improving the response to sepsis is not only about ensuring healthcare providers know what to look for, but also about making sure the systems around them help them act on what they see.

Sullivan is an emergency department physician and site lead for emergency medicine at St. Martha’s Regional Hospital. She also serves as co-lead for emergency medicine in Eastern Zone, and medical director for simulation learning at Nova Scotia Health.  

Her recent work with the Sepsis Improvement Team offers an important perspective on improving sepsis care: sometimes the barrier is not a lack of knowledge, but the gap between how care is designed to happen and how it actually happens at the bedside.

When a clinical practise is not being used consistently, the response can sometimes be to provide more training. Sullivan and her colleagues wanted to understand whether other barriers were getting in the way.

Using translational simulation, they explored how NEWS2 was being applied in practice and how it aligned with the realities of the clinical environment.

One issue they identified was simple but significant: the score generally needed to be entered at a computer workstation, while care for a deteriorating patient was happening at the bedside.

“If a patient’s deteriorating, I’m not going back to my workstation to enter in a score to determine if I need to call somebody to help me with the care of my patient,” Sullivan explained.

This is an example of the difference between what Sullivan called “work as imagined” and “work as done.”

Work as imagined is how a process appears in a policy or workflow. Clinicians receive education, understand the tool and follow the expected pathway.

Work as done is what happens when those expectations meet the realities of a busy clinical environment — a deteriorating patient, competing priorities, technology limitations and communication between members of the care team.

Rather than using simulation only to explore individual knowledge or skills, Sullivan’s team used it to better understand how the system was functioning in practice.

Healthcare teams worked through realistic patient deterioration scenarios and then discussed what supported an effective response and what challenges could make that response more difficult.

Those conversations helped surface aspects of day-to-day care that may not be obvious when looking at a policy or workflow on paper.

The simulation created a space for team members to share their perspectives and better understand one another’s experiences.

It also helped participants see NEWS2 differently.

Following the simulation, participants reported greater understanding of the tool and a stronger likelihood of using it. They also recognized that NEWS2 could only become effective if everyone understood what the score meant.

Sullivan described its potential as a “common language” that can help healthcare providers communicate more objectively when a patient’s condition is changing.

But the larger lesson extends beyond any single tool.

For Sullivan, improving sepsis care means looking closely at the environment in which healthcare teams work.

Sometimes there may be a knowledge gap that education can address. Other times, the clinician may already know what needs to happen, but the workflow, technology or communication structure makes it more difficult to put that knowledge into practise.

“How do we move the gauge from being a provider-based intervention to more of a systems-based intervention that says, how can we support healthcare providers to adequately identify and manage sepsis?” Sullivan said.  

Looking at sepsis through that lens changes how organizations can respond when opportunities for improvement are identified.

Rather than assuming a missed opportunity reflects an individual's failure, teams can ask whether system factors made the right action harder to take.

Sullivan believes that shift can support both patient care and the healthcare providers delivering it. She noted frontline staff often carry the weight of patient outcomes, even when barriers within the system may have contributed.

Using quality improvement to identify those barriers can help change the conversation from blame to support.

“The strongest system empowers their teams to be successful,” she said.  

Improving sepsis care requires awareness of patient deterioration, but it also means listening to the people providing care, understanding the realities of their work and building systems that help them respond when it matters most.  

As part of its commitment to quality and patient safety, Nova Scotia Health continues to strengthen the supports, processes and systems that help healthcare teams recognize and respond to sepsis in a timely and effective way. 

Photo of Dr. Tania Sullivan.