As one of the leading causes of deaths in hospitals, sepsis — a complication often hard to identify — presents a unique challenge to hospital leaders. Since the risk of death from sepsis increases by about 8 percent with each hour before intervention, it is crucial for hospitals to improve sepsis awareness among staff members and speed sepsis responses.
While advancements in technology, such as EHR-based sepsis surveillance, allow hospitals to detect and act on sepsis faster, electronic sepsis alerts fail to help if they don't quickly get to providers who can respond to them.
After finding inefficiencies and a high potential for error in their sepsis treatment process, University of Utah Health, a four-hospital system based in Salt Lake City, partnered with clinical communication solutions provider Spok to help improve sepsis response.
In an Aug. 22 webinar sponsored by Spok and hosted by Becker's Hospital Review, Devin Horton, MD, hospitalist and assistant professor in the division of internal medicine at University of Utah Health, discussed how the health system improved communication around sepsis while cutting septic patients' length of stay.
Identifying problems in sepsis response
Dr. Horton began to identify problems in sepsis response while evaluating patients with fevers. "When I was consulting for a fever, I'd go see a patient, get into their chart and find they had abnormal vital signs that had been there for several days," he said. "Our EHR imports those notes every day, but there were no discussions about those vital signs."
At patient bedsides, nurses would take vital signs and continue this process for four or five other patients, making the first vital signs up to an hour old by the time they were entered into the computer. "If this was an emergent case, we'd already lost an hour," Dr. Horton said. "There may not be communication about those vital signs, they may just sit in the computer waiting for the nurse to see them and a provider may not get back to them quickly."
Some of the health system's providers couldn't put the pieces together to say it was sepsis, Dr. Horton said. "And as we started looking into it, we realized we had no real process in place at our institution to address sepsis as a leading cause of death."
If there was a way to get the vital signs in the notes sent to a provider who knows what to do with them, the hospital could ensure patients aren't slipping through the cracks, Dr. Horton said.
Leveraging communication platforms to improve sepsis response
To address this issue, University of Utah Health leveraged their EHR system with Spok Care Connect, which takes the EHR's sepsis alert or a critical test result and sends it to the right clinicians' mobile device automatically.
The alert contains the information clinicians need to act right away, including who the patient is, their room number and their modified early warning score, or MEWS. MEWS is a physiological test that prevents delays in the intervention or transfer of critically ill patients. The alert is sent in seconds, allowing the care team to respond faster.
University of Utah Health's EHR automatically uses vital signs entered to calculate the MEWS score. If the MEWS is sufficiently high, Spok sends that MEWS alert as a message to either the charge nurse or the rapid response team. When vitals are outside normal range, the recipients get a notification to begin intervention on that patient right away.
"What was helpful for us was having all our sepsis data in one place — we can look at the data and take it back to our providers to tell them what we're seeing," Dr. Horton said. "If you have an EHR-based algorithm, patients' illness can be detected earlier on and resuscitated earlier on."
The data University of Utah Health collected also allowed them to look at the odds of septic patients getting antibiotics within the first 24 hours, Dr. Horton said.
"For all sepsis patients, we saw a length of stay that was decreased by 10 percent and because of that our total direct cost decreased by 10 percent."
Continuing to improve sepsis detection and awareness
As hospitals look for ways to prevent patient mortality and improve communication among staff, understanding what sepsis recognition and detection looks like is key to providing timely and effective care.
For University of Utah Health, the results from implementing this new workflow for sepsis response demonstrated the importance of hardwiring communications for sepsis management.
"We can have the best hospital in the world, but if you don't know what vital signs are, and if the vital signs aren't entered into the computer in real time, then that patient is losing, and the institution is losing," Dr. Horton said.
To listen to the full webinar recording, click here. Click here to learn more about the Spok Care Connect platform.