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October 4, 2017

How UCHealth reduced sepsis mortality by 15 percent

Daily Briefing

    University of Colorado Health (UCHealth) leveraged its EHR to implement a sepsis alert process that accelerated its response and cut the sepsis mortality rate at its flagship hospital by 15 percent in less than a year, Maria Castellucci writes for Modern Healthcare.

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    As of last year, 10 percent of patients with sepsis at died from the condition. To reduce that rate, officials conducted an internal study and found that some septic patients did not receive needed antibiotics promptly enough. According to CMS, antibiotics should be administered to patients with sepsis within three hours, but at UCHealth, patients regularly waited three hours or longer.

    UCHealth found that, if a patient received their antibiotics within an hour of their sepsis diagnosis, the sepsis mortality rate dropped by 50 percent. "The biggest predictor of mortality in our sepsis patients was timing of antibiotics," said Jeffrey Glasheen, UCHealth's chief quality officer.

    How it works

    To reduce response time, officials developed a multistep process that uses patients' EHRs to identify patients at risk of sepsis.

    The EHR monitors patients' vital signs and alerts a nurse of any abnormalities. The nurse then checks for other signs of sepsis and enters those symptoms into the EHR, which determines whether the patient has a low, medium, or high probability of sepsis.

    Patients determined to have a medium or high probability are seen by the sepsis team—a group of caregivers made up of a nurse, pharmacist, and physician or advanced practitioner who are dedicated to making quick sepsis diagnoses. If the team determines a patient to be septic, then antibiotics are immediately ordered, and the prescription is marked as urgent to ensure the pharmacist fills the order within the hour.

    Nurses also receive a workflow checklist to ensure the process is followed, and they receive support from the sepsis team in administering the antibiotics, Castellucci reports.

    Positive results

    The health system in January implemented the new process at University of Colorado Hospital.

    Since then, the program has reduced the hospital's sepsis mortality rate by 15 percent, leading to about 39 lives saved, and has lowered by 11 percent the length of stay in intensive care units.

    "By recognizing sepsis sooner and getting people antibiotics sooner, they have go to ICU much less frequently and for much less time," Read Pierce, physician co-chair of the sepsis steering committee at University of Colorado Hospital, said.

    The health system has reduced the amount of time it takes to get patients their antibiotics to about 75 minutes—still above their 60-minute-or-less initial goal, but Pierce believes they'll reach that milestone soon (Castellucci, Modern Healthcare, 10/2).

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