CMS and the Agency for Healthcare Research and Quality (AHRQ) estimate that sepsis costs the U.S. healthcare system about $38 billion annually. As Americans age and hospitalized patients become more clinically complex, those costs have been increasing.
At a session sponsored by Wolters Kluwer at the Becker's Virtual CEO + CFO Roundtable, Kristy Drollinger, VP product innovation, Clinical Surveillance & Compliance at Wolters Kluwer, Health, discussed how hospitals and health systems can deliver better patient outcomes and strengthen the bottom line by improving sepsis care.
Five key takeaways were:
- Most hospitals lose money on every sepsis case and most hospitals have many patients with sepsis. According to AHRQ, sepsis is the most expensive type of hospital stay. The condition can quickly progress in severity and costs rise significantly as condition severity increases. When sepsis develops in the hospital, it can result in much longer lengths of stay. In addition, sepsis affects older patients more frequently. Consequently, around two-thirds of sepsis cases are paid for by Medicare. Unfortunately, treatment costs far exceed reimbursement.
- Sepsis responds favorably to early intervention. Numerous studies have shown that sepsis responds to a standard bundle of care. In response, CMS has implemented a multi-step quality measure that evaluates compliance with a standard sepsis treatment protocol called the SEP-1 bundle. "Patients who receive care that conforms with the bundle have shorter lengths of stay; lower utilization of high-cost services like intensive care, ventilators and dialysis; lower mortality and lower readmissions. It's in everyone's best interest to identify sepsis early and deliver care according to the sepsis protocol," Ms. Drollinger said.
- Although the SEP-1 protocol works, most hospitals are inconsistent in delivering care according to the bundle. National compliance with SEP-1 bundle standards is only around 50 percent. "There are various reasons why hospitals struggle with this measure," Ms. Drollinger said. "Many conditions can look like sepsis. In addition, sepsis alerting systems generally suffer from poor alert quality, so clinicians tend to ignore them. As a result, sepsis patients are identified late and care is delayed." Another challenge is that the SEP-1 bundle is delivered over multiple hours. Without sepsis management tools in place, it's hard to track which steps were completed and when.
- Hospitals that perform well on sepsis care have broad, cross-functional sepsis programs. Solving difficult quality improvement problems like sepsis care requires cross-functional programs where people, process and technology are consistently applied. "Staffing constraints are the major people challenge facing most hospitals. Sophisticated surveillance technology can be part of the solution. It's always running in the background, monitoring patients and helping care teams identify issues. Care teams can then react to changing patient status quickly and provide care consistent with hospital policy," Ms. Drollinger said.
On the process side, many clinical and quality leaders spend considerable time and resources on sepsis solutions that only deliver small, incremental improvements. "In many cases, engaging an expert team can help organizations reach their goals much faster," Ms. Drollinger said. "EHR-based sepsis management solutions are blunt instruments that do a poor job of supporting care teams and delivering positive outcomes."
- Sepsis management technology reduces workloads, increases productivity and improves provider satisfaction. Wolters Kluwer Sentri7® Sepsis Monitor is a fully automated clinical surveillance system that integrates with the EHR to monitor patients and identify individuals with sepsis early, with the highest accuracy available. Sepsis Monitor matches teams' existing workflows, routing alerts directly to the EHR or to mobile devices to limit change management effort.
New team members like sepsis coordinators need tools to see every patient who may have sepsis and centrally monitor their care with respect to the SEP-1 bundle, so Sepsis Monitor includes a full hospital population monitor view. For sepsis committees and quality improvement teams, Sepsis Monitor provides sepsis-specific analytics to track program outcomes like length of stay, mortality, readmissions and bundle compliance. "This is the most comprehensive sepsis solution available. Our expert implementation teams tune Sepsis Monitor to match each customer's workflow. The goal is to optimize performance, while minimizing disruption and change management," Ms. Drollinger said.
After implementing Sentri7® Sepsis Monitor, Conway Regional Medical Center in Conway, Ark. improved SEP-1 bundle compliance by more than 20 percent over four months and achieved $1.2 million in annualized length-of-stay savings.
"Senior leadership has a key role to play in improving sepsis performance," Ms. Drollinger said. "It takes raising sepsis up in your hospital priorities, focusing on processes and making the right investments in people. It's also essential to assess your approach to advanced technology that can drive outcomes and critically evaluate your approach to build versus buy to ensure that you get the expected ROI from technology investments. Don't let a do-it-yourself strategy deliver sub-optimal clinical and financial performance."