Editor's note: This popular story from the Daily Briefing's archives was republished on April 15, 2020.
OhioHealth cut its sepsis mortality rate by 4.3 percentage points by educating staff, using a new diagnostic tool, curbing medication response time, and fostering a forgiving attitude towards false alarms, Christopher Cheney writes for HealthLeaders Media.
When the four-part initiative launched in 2015, OhioHealth's sepsis mortality rate was 24.3%, and by the end of 2017, it was down to 20%. According to James O'Brien, the director of quality and patient safety at OhioHealth, "Our estimate is that we have saved about 250 lives."
Inside OhioHealth's initiative
Cheney details the four steps OhioHealth used to reduce its sepsis mortality rate:
- Education efforts
According to O'Brien, one of the key aspects to OhioHealth's sepsis mortality rate reduction initiative was educating thousands of workers in the health system about sepsis and showing them areas where improvements could be made—particularly in emergency care.
Cheney writes that the initiative honed in on emergency care providers, working both internally at EDs and externally as emergency medical service workers. "We've worked through the Central Ohio Trauma System to get into the mindset of the emergency medical responders because they are significantly as likely to be transporting a patient to one of our hospitals with sepsis as with a heart attack or stroke," said O'Brien.
- A new diagnostic tool leads to quicker response time
As part of the initiative, OhioHealth also cut down the time it takes to test for sepsis and identify the best antibiotic treatment by using a new test from BioFire Diagnostics.
According to O'Brien, previous tests involved a two-step process: first you test a blood culture for sepsis and then, if positive, you then have to test the blood culture against antibiotics to identify the best treatment. The new test has just one step: Once a blood culture tests positive for sepsis, the tool molecularly tests the culture and figures out which antibiotic would be most effective.
"Once a culture is positive for sepsis, this test helps us to very quickly get to which antibiotic will work best for the bacteria, and, just as important, which antibiotic won't work," O'Brien said.
- Reduced medication response time
According to O'Brien, pharmacists are expected to have the antibiotic at the patient's bedside within an hour of it being prescribed.
Since there is no standard way to curb pharmacy response times throughout the system, OhioHealth has improved response times by staffing the Sepsis Improvement Teams—which are at every hospital in the system—with pharmacy representatives, Cheney writes. The six-member teams also include a health care information technologist, a lab staff member, a nurse, and a physician.
- A forgiving attitude towards false alarms
To ensure rapid treatment for sepsis patients, the health system has also implemented a climate of forgiveness for "false-alarm" diagnoses, according to O'Brien. "We have to be really careful to understand that clinicians are doing a difficult task in trying to figure out what to do, because this is a disease for which there is no single test that says, 'This is absolutely sepsis,'" he said. "They are making decisions with uncertainty."
One key component to building that atmosphere is supporting the diagnoses and medication decisions of clinicians. "If you go back and beat up the clinicians for having given antibiotics when they were uncertain what the problem was, that's just unfair to them," O'Brien said (Cheney, HealthLeaders Media, 1/25).
The Sepsis CVR Starter Kit: Implementation resources from Emory Healthcare
Despite the availability of evidence-based care standards for sepsis, workflow complexities at the front lines can cause delays to timely diagnosis and treatment.
This toolkit provides downloadable templates and examples from a successful sepsis care variation reduction (CVR) strategy. Use these tools to jumpstart your own care variation reduction efforts, and scale those efforts system-wide.