With an EHR-based surveillance screening tool, Frederick Memorial Hospital in Frederick, Maryland, reduced sepsis mortality by 65%, Christopher Cheney reports for Health Leaders Media.
A pervasive challenge for hospitals everywhere
Each year, more than 1.7 million adults in the United States suffer from sepsis—a dangerous a medical complication resulting from the body's inflammatory response to an infection. The condition plays a role in more than 250,000 U.S. deaths annually.
In 2012, Debra O'Connell, an RN and manager of performance improvement at the Frederick Memorial, said the hospital looked at the available data and determined it needed to change its approach to sepsis mortality. "[W]e recognized that our mortality level was one-and-a-half times what the expected values were based on coding and auditing of charts, and patient comorbidities," O'Connell said. "[W]e did not have good bundles or processes … in place to even identify patients who were at risk of sepsis."
So hospital officials set a goal of improving sepsis screening. The outcome was an EHR-based screening tool.
How Frederick Memorial's tool works
Frederick Memorial developed the EHR-based tool to better identify which patients are at greatest risk for sepsis, Cheney reports.
Here's how it works. The EHR features a screenshot that "provides the clinical staff and the nurses with some fundamental questions about the patient's status," O'Connell explained. Specifically, the tool asks users, predominantly nurses, about a patient's vital signs, potential sources of infection, white blood cell levels, and changes in a mental state, according to O'Connell. Based on the answers, the tool calculates a score for the patient. Any score higher than two indicates the patient might have sepsis and the nurse is required to call a physician for additional orders, O'Connell said.
Frederick Memorial tested the tool in a clinical trial, and slowly rolled it out to hospital providers. First, they launched it in the ED and used it to address one-off incidents elsewhere in the hospital, according to O'Connell.
After that, the hospital made the tool available to clinicians all over the hospital, O'Connell said. The tool had a big impact, O'Connell said. From 2012 to 2016, Frederick Memorial Hospital saw its infection's mortality rate fall by 65%.
In 2017, Frederick Memorial started using the tool to screen all inpatients. Now, patients are screened on admission and then twice a day after that, according to O'Connell.
May 15 WebconferenceHow Emory answered 6 key questions to curb sepsis care variation
The secrets to success
The two keys to successful adoption, according to O'Connell were "physician champion leadership" and dating sharing.
"The biggest thing is finding some physician champions who can help drive the processes, the culture change, and education of the entire staff," O'Connell said. A Frederick Memorial, O'Connell said there was one physician leader in particular who helped drive Frederick Memorial's adoption.
Data sharing was important too, O'Connell said. "Once we were able to demonstrate that there were benefits from the screening tool, identifying septic patients, and that our treatments were decreasing mortality rates, that made a big difference with our staff."
Initially, some nurses resisted the call to screen all inpatients daily, O'Connell said. However, showing nurses that the tool really was associated with reduced mortality helped with broader adoption.
"We don't want to miss opportunities to capture sepsis because it is a severe disease process. You can go downhill very quickly …. That is the point of trying to capture sepsis by screening two times a day" (Cheney, HealthLeaders Media, 4/9).
Advisory Board's take
Sarah Evans, Practice Manager, Physician Executive Council
Sepsis care is all about speed—there's a critical link between early intervention and survival. That's why automating surveillance with universal sepsis screens—like the one implemented by Frederick Memorial Hospital—is such an important tool in the race to identify sepsis cases.
“Many sepsis protocols that work well on paper don't always translate”
That challenge is that even when clinicians identify suspected sepsis cases early on, treatment is often delayed by workflow complexities. The reason? Clinical guidelines for sepsis are clear—but how to implement them is often less so. Many sepsis protocols that work well on paper don't always translate as well to frontline clinician practice.
In our research on care variation reduction, we've identified six questions that all care standard design teams should answer in order to surface (and address) workflow complexities that could prevent clinicians from following the standard of care:
- How much of the full care pathway can the organization address, given available resources?
- Which components of the care pathway should the organization standardize first?
- What workflow enablers—such as training, equipment, or available personnel—do clinicians need to translate the care standard into daily practice?
- How will the organization roll out the new care standard successfully?
- How will the organization reinforce adherence to the care standard over time?
- How will the organization know what's working—and what's not?
To learn how one organization answered these questions to successfully reduce sepsis care variation, join our webconference Reduce Care Variation to Improve Sepsis Outcomes: Lessons from Emory Healthcare on May 15th at 1 pm ET. I'll be sharing insights into Advisory Board's care variation reduction framework and a case study on Emory Health's sepsis work.
In the meantime, make sure you download our infographic to learn four common pitfalls that doom efforts to engage physicians in care variation reduction—and the four keys to overcome them.