The keys to combating sepsis: Change management processes and decision-support tools

Sepsis may be one of the biggest killers in the U.S., yet it is not a condition with which many average Americans are familiar. Nevertheless, hospitals are always looking for new ways to catch and treat sepsis as early as possible, to improve patient outcomes and reduce mortality rates.

"Sepsis is one of the most significant diseases in the United States that people tend to not know about," Stephen Claypool, MD, medical director of the Innovation Lab at Wolters Kluwer, said in a recent webinar. "It's fairly common — it kills an awful lot of people and costs an awful lot of money — and yet it is not as well-recognized as some of the other major diseases." 

Despite the frequency of cases, sepsis care is suboptimal throughout the U.S., a fact that drove Wolters Kluwer to create a decision support system for the condition, according to Dr. Claypool.

Wolters Kluwer's system, called POC Advisor, pushes patient-specific alerts and evidence-based treatment advice directly to the point of care on smart devices carried by clinicians on the hospital's front lines.

Wolters Kluwer has collaborated with several healthcare institutions to roll out POC Advisor at the point of care, including Huntsville (Ala.) Hospital, a community-owned and operated facility with more than 900 beds across three campuses.

According to Joycelyn Craighead, RN, BSN, director of quality at HuntsvilleHospital, the hospital committed to implement the Wolters Kluwer tool after sepsis reduction was identified as a hospitalwide priority.

"We had some internal initiatives in place, but they really were not giving us substantial changes in our patient outcomes," said Ms. Craighead. That said, Huntsville jumped at the chance to pilot a study with Wolters Kluwer in a couple of units that had higher rates of sepsis-rated deaths.

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 hospital then implemented the sepsis decision support system from October 2013 to February 2014.

To ensure the best possible quality improvement results, Huntsville coupled the implementation of POC Advisor with several drastic change management processes, including the formation of nursing unit teams to lead the change efforts, sepsis and physician steering committees, new order sets and protocols and educational sessions for the hospital leadership.

The Huntsville team hypothesized both the change management processes and POC Advisor's electronic alerting and decision support would be a winning combination to combat sepsis.

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"In order for the change management efforts to work…we decided electronic alerting would be a definite improvement in functionality to boost compliance with the bundle," said Ms. Craighead.

Although the hospital wanted to add electronic alerting to its sepsis-reducing efforts, it was important to choose a system that had excellent sensitivity and specificity to minimize the likelihood of alarm fatigue. POC Advisor did just that by building an expansive set of rules that could be tailored to patients' comorbidities and Huntsville's work sets.

To discern whether a patient has sepsis, the Wolters Kluwer tool pulls information from patients' EHRs. Some information gathered by POC Advisor includes vital signs, medications, patient demographics and lab results.

When POC Advisor does identify an issue, it sends three types of alerts to the clinicians:

1. The diagnosis concluded from the patient's screening

2. Evidence-based treatment advice in line with the hospital's order sets

3. Reminders to acknowledge the alerts or escalate the alerts according to the site's protocols

In the case of HuntsvilleHospital, the alerts were sent to the nursing staff via iPod touches. That said, POC Advisor can be adjusted to send alerts to whichever recipients a hospital specifies, on most mobile device, including smart phones, pagers and tablets.

Comparing Huntsville's data from the pre-implementation period with data from the 10-month post-implementation period revealed a 53 percent reduction in sepsis-related mortality, from 9 percent to 4.2 percent. The hospital also recorded a 30 percent decrease in sepsis-related readmission, from 19.08 percent to 13.21 percent, and a downward trend in the average length of stay related to sepsis cases.

"Our summary is that a sepsis improvement program that uses change management to initiate sepsis screening protocols, communication and order set protocols, as well as an electronic surveillance system with high alert sensitivity and specificity, can improve sepsis mortality and other outcome measures," said Dr. Claypool.

To learn more about how POC Advisor works, watch the video below and visit www.pocadvisor.com.

To learn more about the trial at Huntsville Hospital, view the full webinar by clicking here.

Note: View archived webinars by clicking here.

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