Prescription for Change

Emory cut sepsis mortality from 13% to 8% and saved millions in the process. Here's how.

by Taylor Hurst and Dylan Jennings

Editor's note: This popular story from the Daily Briefing's archives was republished on March 22, 2019.

Sepsis care is all about speed; there is a critical link between early intervention and survival. The challenge is that sepsis cases are notoriously difficult to diagnose accurately, and logistical complexity can cause delays to timely treatment.

Emory's streamlined process

To fast-track the process, leaders at Emory turned to the clinicians who were already at the patient bedside: nurses. Emory created a simple screening tool in its EHR that enables nurses to quickly identify—and then elevate—suspected sepsis patients. As soon as a sepsis alert fires, the EHR prompts the nurse to answer two questions:

If the nurse answers "yes" to both questions, the system confirms the patient screened positive for suspected sepsis, and it launches a series of automated next steps to speed up treatment.

  1. 'Code Sepsis' quickly alerts response team: First, the EHR automatically prompts the nurse to call "Code Sepsis." A Code Sepsis Response Team—including a physician, pharmacist, and phlebotomist—receive a notification to respond to the suspected sepsis case before their next patient.
  2. Nurse-initiated PowerPlan reduces lag between alert and action: Second, the EHR automatically launches a Nurse-Initiated PowerPlan. Everything in the PowerPlan is standardized and pre-checked, including labs, imaging, and fluids. Nurses approve the PowerPlan so that vital steps are set in motion—even before the responding physician arrives on scene—to speed up diagnosis and treatment. Importantly, there are no antibiotics included in the nurse-initiated order set.

  3. Physician-initiated antibiotic PowerPlan ensures timely delivery: Third, an Antibiotic PowerPlan automatically launches as soon as the responding physician logs into the EHR. This PowerPlan includes a standardized first course antibiotic. Once the physician identifies the source infection, the PowerPlan defaults to the most appropriate antibiotic.

Reaping the benefits of a rapid response

Since implementing the new care pathway, Emory has reduced the time to first course sepsis antibiotics from 95 to 22 minutes on average. In addition to saving lives, Emory has saved $1.8 million annually, largely by reducing length of stay and the proportion of patient days spent in the ICU.

Learn more: 10 Imperatives to Reduce Sepsis Mortality

Reviewing sepsis mortality statistics is a sobering exercise. In 2008, only 2% of hospital patients were diagnosed with sepsis, but it was responsible for 17% of hospital deaths.

This research report includes ten tactics to build a system of care that promotes early identification, coordinates care team responsibilities, and delivers timely treatment for every sepsis patient, every time.

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