Sepsis is notoriously difficult to recognize and treat, but some hospitals are designing change management strategies and leveraging their electronic medical record data and surveillance technology to improve patient care.
Joycelyn Craighead, RN, BSN, director of quality at Huntsville (Ala.) Hospital, and Stephen Claypool, MD, medical director of the Innovation Lab at Wolters Kluwer, spoke about five best practices for reducing sepsis mortality at the Becker's Hospital Review 7th Annual Meeting in Chicago.
According to Ms. Craighead, change management was an integral part of the hospital's sepsis reduction efforts.
"Change management was key for us at Huntsville," she said. "I can honestly say, having been in this position for about 10 years, that this was the first time I really had the chance to work in a true change management process. I learned that if you do not have a solid change management process in place, you will not be as successful in your endeavors as you could have been."
The sepsis-related change management process at Huntsville Hospital included:
1. Forming nursing unit teams. Nursing unit teams empowered the staff to be a part of the change and help make decisions relevant to the end user's care.
2. Creating physician steering committees focused on sepsis. Having physicians work with health IT and other multidisciplinary groups on the committees boosted engagement, created excitement and helped the hospital identify sepsis program leaders and champions.
3. Providing formal, didactic education sessions. "Just because you are a nurse or a doctor, it does not mean you truly understand the cascade of sepsis, especially if you received your medical training 20 years ago," said Ms. Craighead. Educational session can refresh everyone on the latest information in sepsis diagnosis and treatment.
4. Designing order sets and established protocols. For instance, the hospital built a protocol to draw point-of-care screening lactates. Having the front-line staff involved in the creation of the order sets and protocols was empowering.
5. Utilizing point-of-care alerting. By using a highly sensitive and specific electronic alerting system, the hospital could reduce alert fatigue, standardize processes, boost compliance to treatment pathways and improve patient care.
Huntsville Hospital used Wolters Kluwer's system, called POC Advisor, to conduct a pilot study on using real-time surveillance and analytics to reduce sepsis mortality. The system pushes patient-specific alerts and evidence-based treatment advice directly to the smart devices carried by clinicians on the hospital's front lines.
During the baseline period between January and September 2013, Huntsville recorded sepsis-related lengths of stay and mortality rates that were well above the national average. The sepsis decision support system was then implemented from October 2013 to February 2014.
Examining data from the study, Huntsville Hospital saw a 53 percent reduction in sepsis-related mortality, from 9 percent to 4.2 percent, between the pre- and post-implementation period. The hospital also recorded a 30 percent decrease in sepsis-related 30-day readmission rate, from 19.08 percent to 13.21 percent, and a downward trend in the average length of stay related to sepsis cases.
"Overall, we are very pleased with the outcomes at Huntsville," said Dr. Claypool. "It just goes to show a program consisting of change management and an electronic surveillance system that is highly sensitive and specific can improve sepsis mortality significantly, along with other outcomes."
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4 key elements of early sepsis recognition and response