Making the Stars Align When Time Matters: Leveraging Actionable Data to Combat Sepsis
Licking Memorial Health Systems
Patient Impact
Where did we begin? EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION EDUCATION.and then some EDUCATION.
Sepsis Statistics are Grim Source: Sepsis Alliance. Sepsis Fact Sheet. http://www.sepsis.org/downloads/2016_sepsis_facts_media.pdf MEDITECH. MEDITECH s EHR Alerts Clinicians to Possible Sepsis. October 2014.
Sepsis Statistics are Grim, cont d Source: Sepsis Alliance. Sepsis Fact Sheet. http://www.sepsis.org/downloads/2016_sepsis_facts_media.pdf
Keys to Sepsis Survival Early Recognition The onset of sepsis can be subtle Urgent Attention Can progress very quickly if left untreated Rapid Treatment: Antibiotics IV Fluids
LMH Initiatives Establish a Sepsis Committee Establish a Sepsis Alert Protocol automatic ED acuity = RED Increase staff & physician awareness through ongoing education & case feedback Real-time case monitoring & ED case review Outlier identification and education with providers, pharmacists and nursing staff Standardize care via order sets and protocols
LMH Initiatives, cont d Screening of ALL triage patients for sepsis (using nurse protocols to initiate the Sepsis Alert, IV insertion, blood cultures, and fluid bolus if criteria met) Leverage technology to assist in sepsis identification via early warning systems Sepsis Visual Smart Board Real-time communication of at risk patients to providers
LMH Sepsis Team
Education & Awareness Campaign Overview of Sepsis Signs & Symptoms Sepsis Levels Treatment regimen CMS Sepsis Bundle Targeting: SNF and EMS Providers in our Community!
Sepsis Progression
Education & Awareness The Sepsis Bundle Within 3 hours of severe sepsis/septic shock identification: Obtain lactate level Obtain blood cultures Administer a broad spectrum antibiotic If hypotensive, administer 30mL/kg crystalloid fluid bolus Within 6 hours of severe sepsis/septic shock identification: Repeat lactate level, IF initial level was elevated >2mmol/L Vasopressors, IF hypotension persists after the 30mL/kg crystalloid fluid bolus Repeat volume status and tissue perfusion assessment
Early Management Bundle Results National Average: 44.2% Licking Memorial: 55.2%
LMH Information Technology Initiatives 1. Standardize care via order sets and protocols 2. Leverage existing EHR technology to assist in sepsis identification 3. Implement new sepsis surveillance system 4. Communicate condition of at risk patients in real-time 5. Detect patient deterioration earlier
Information Technology Initiative #1 Develop Standardized Clinical Workflows & Documentation
Standardized Physician Documentation CPOE Enabled Sepsis Specific Order Set
Standardized Physician Documentation (2) Sepsis Specific Physician Progress Note -Automatically populates key information
Standardized Physician Documentation (3) Sepsis Specific Progress Note - Consolidates CMS required elements
Information Technology Initiative #2 Improve Sepsis Identification using MEDITECH EHR
MEDITECH Sepsis White Paper Sepsis algorithm based upon the Surviving Sepsis Campaign Framework Build upon existing EHR functionality Generate EHR notifications for possible sepsis using real-time nursing documentation & a tailored sepsis identification algorithm
Sepsis Identification Nursing Documentation Nursing Sepsis Admission & Shift Assessments Calculates each patient s risk of Sepsis based upon vital signs, mental status & suspicion of infection
Room for Improvement A good first step but... We knew we could do better!
Information Technology Initiative #3 Implement Sepsis Surveillance System
Sepsis Visual Smart Board Based upon CMS Sepsis Bundle Criteria Aggregate all key data in a single location Every inpatient evaluated in real-time Provides comprehensive overview of patient s current condition Categorizes & color codes patients by risk Includes physician documentation regarding infection or suspicion of sepsis
Underlying VSB Algorithm
Sepsis Visual Smart Board, cont d
Improved Results Lab results & organ dysfunction elements necessary to stratify patients by categories of risk are incorporated Fewer false positives Less interruptions for physicians & staff Better visualization of at risk patients Earlier detection of sepsis onset
Information Technology Initiative #4 Facilitate Real-time Communication of Critical Alerts
Sepsis VSB Integration with Imprivata Cortext Secure Texting
Information Technology Initiative #5 Detect Patient Deterioration Sooner
Key Predictors of Patient Deterioration The two most important predictors of potential adverse events: Heart Rate Respiratory Rate
EarlySense Contact Free Continuous Patient Monitoring System
Continuous Patient Monitoring Benefits Alerts to adverse changes in vital signs either in real-time or as vital sign trends over time Assists in detection of patient deterioration earlier than when compared to traditional monitoring Nursing staff receive alerts via Vocera as well as to display monitors
Our Organizational Results... Overwhelmingly Positive!
Patient Impact Increased Identification of Sepsis
Patient Impact Code Blue Rate Reduced 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 1.8 1.0 January 2015 - December 2015 March 2016 - December 2016 Code Blue Rate Per 1000 Patient Days Nearly a 45% decrease in Code Blue Rate
Patient Impact Decreased Sepsis Mortality Rates
Patient Impact Mortality Reduced
Top Reasons for Our Success High level of collaboration among Sepsis Team members Leveraging technology to assist in identifying sepsis in real-time Providing push alerts to clinical staff & physicians On-going review of outliers & continual process improvement related to sepsis care
Question & Answer Sallie Arnett, MS, RHIA, CHCIO sarnett@lmhealth.org 220-564-2400 Brian Thatcher bthatcher@lmhealth.org 220-564-4354