Sepsis Management at Russell Medical Sarah Beth Gettys V.P. Patient Services Russell Medical Dr. Michele Goldhagen MD, CMO, ED Medical Director Russell Medical Oct 3, 2017 1
Objectives List key success factors in developing an effective multidisciplinary team focused on sepsis Identify tools for hardwiring sepsis interventions into your culture Gain knowledge in ways to utilize data to drive quality 2
Russell Medical Alexander City, AL 3
Russell Medical Alexander City, AL 4
Multidisciplinary Sepsis Team Chartered July 2015 VP Patient Services Chief Medical Officer IT Nursing Specialist HIM Coding Specialist Lab Director Director of Quality Hospitalist Medical Director ED, ICU, Med-Surg Nurse Managers Medical Records Pharmacy Director Infection Prevention Nurse Quality Abstractors 5
Team Goal: Implement the Sepsis Bundle First Steps Facilitate rapid recognition of Sepsis in the ED Developed Order sets Developed Screening tool Screen positive (time zero) Created a mechanism to reflex order an elevated Lactate 6
Team Goal: Implement the Sepsis Bundle Most crucial steps: Physician Engagement Physician Communication Chief Medical Officer ED Physician ED Medical Director Hospitalist Medical Director 7
Team Goal: Implement the Sepsis Bundle Key Steps: Communication regarding our efforts Creating Accountability Quality Leadership Team Governing Board Driven 8
Team Goal: Implement the Sepsis Bundle Team Activity: Team Meetings every 2 weeks Standing agenda: Overall compliance How is the system working? Allowed for CMO / ED Nurse Manager to share successes of the Bundle compliance 9
Team Goal: Implement the Sepsis Bundle 10
Implementing the Sepsis Bundle Compliance Tracking Tool: Missed Opportunity Report Department specific Physician specific Bundle component specific 11
What were we missing as an organization? 12
Plans for dashboard: 100 Top Simulation Dashboard for Russell Medical Presentation at annual Leadership Retreat Use as the new Quality Communication tool 13
Quality Indicators Quality Dashboard Implemented September 2016 10.00 8.00 6.00 4.00 2.00 4.68 6.89 5.43 4.46 4.64 3.87 3.28 2.84 2.44 2.69 3.76 O/E Ratio Trendline 4.94 Ratio Definition Analysis Observed Deaths / Expected Deaths (Risk Adjusted) Ratios are calculated using Truven Health risk-adjustment methodology (RAMI). Expected values are based on the Top 10% Benchmark. An o/e ratio below 1.0 indicates performance is better than the norm. Mortality continues to be higher than the benchmark for all 12 quarters. In the last 12 months the leading mortality opportunity is Sepsis. 0.00 2014 - Q2 2014 - Q3 2014 - Q4 2015 - Q1 2015 - Q2 2015 - Q3 2015 - Q4 2016 - Q1 2016 - Q2 2016 - Q3 2016 - Q4 2017 - Q1 Observed/Expected Ratio Mortality: 12 Quarter Trend 14
Quality Communication within the Organization Executive Leader Rounds - living the process Monthly Birthday meetings Departmental Postings Quarterly Governing Board quarterly meetings 15
Key Success Factors Creating Accountability Engaging Physicians Communicating Clearly expectations and results Celebrating achievements Becoming a Data Driven organization 16
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Talk is cheap and easy simply mandating change is transient, at best, and will not lead to total physician buy-in Motivating Physicians to change attitudes and behaviors is more permanent, reliable, and sustainable 2 separate groups of Physicians to convince ED and HM 19
Educating Physicians that early identification and treatment of Sepsis saves lives Creation of ED Sepsis order sets Creation of HM admission Sepsis order sets Creation of Septic Shock re-evaluation - documentation template Participation in creation of nursing Sepsis handoffsheet 20
Common Characteristics 1. Saving Lives 2. Competitiveness 21
2016 4 TH QTR DATA Sepsis Treatment Bundle 3 hr window 91% Sepsis Treatment Bundle 6 hr window 82% 22
Data was posted in the ED and HM office 23
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2017 1 ST QTR DATA Sepsis Treatment Bundle 3 hr window 84% *** Sepsis Treatment Bundle 6 hr window *** 88% 26
2017 2 ND QTR DATA Sepsis Treatment Bundle 3 hr window 85% Sepsis Treatment Bundle 6 hr window 94% 27
GOING BEYOND THE WALLS OF THE HOSPITAL 28
OUTSIDE THE BOX Going a step beyond! Identifying sepsis early and initiating treatment pre-hospital Physician s Clinics Nursing Homes EMS 29
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