Fending off sepsis before it strikes

Sepsis is no minor problem, in regards to a patient's health or a hospital's financial health. Hospitals rack up an average of $23.6 billion annually for sepsis care, making it the most expensive condition treated in hospitals, according to a Healthcare Cost and Utilization Project report.

Sean Benson, of Wolters Kluwer, Clinical Software Solutions in Minneapolis, discussed the issue of sepsis mitigation at Becker's 2nd Annual CIO/HIT + Revenue Cycle Conference, emphasizing sepsis is a "big patient safety issue, quality issue, but also financial issue."

During his presentation titled, "The ROI of technology-enabled sepsis mitigation," Mr. Benson highlighted his company's sepsis mitigation product, POC Advisor, which is a decision support system pinpointing escalating conditions early and sending alerts and evidence-based treatment advice to the point of care.

Wolters Kluwers conducted an analysis on how hospitals are handling sepsis care from a financial perspective, and found many hospitals were losing more than $1 million yearly on sepsis care.

The company then initiated a study on sepsis care and related challenges in about 50 healthcare systems. The study uncovered a lack of protocols, training issues, time delays and a need for data analytics were all hindering proper sepsis care. This proves problematic, as time is of the essence for septic patients — every passing hour a septic patient goes untreated, his or her mortality chances go up by 8 percent.

"The good news in all this, is that [sepsis] is a known thing and people know how to treat it," said Mr. Benson. "The biggest thing is identifying those patients early and delivering the right treatment."

Five years ago, Wolters Kluwer set out to build a system that addressed these major workflow issues in septic care. They wanted to establish a highly specific and highly sensitive system, meaning a system that catches all the patients and doesn't send out a great amount of false positives.

POC Advisor is a platform with a variety of condition modules. The system gathers clinical system data in real time, and ensures it is codified so machines can read it. POC Advisor runs the gathered data against the hundreds of rules Wolters Kluwer established representing clinical scenarios. "When a rule fires positively, we send alerts to the point of care," says Mr. Benson. "It's delivering evidence-based, patient-specific, actionable advice to the point of care."

Every health system decides how it wants the POC Advisor to deliver alerts. Mr. Benson said they recommend sending the alert to the bedside nurse via a mobile message, because that nurse will know the patient best. The rapid response team or physician receives the next alert. Ideally, the alert receiver will then input the data into the patient's electronic health record.

Once the septic patients are identified, Mr. Benson said ordering lactate at point of care and simplifying the antibiotics administration process proves key.

Huntsville (Ala.) Hospital serves as a POC Advisor case site, having implemented the system a couple of years ago. Based on this case site, Wolters Kluwers published a paper in the Journal of the American Medical Informatics Association in early 2016.

The paper reveals the POC Advisor decreased sepsis mortality by 53 percent and achieved a sensitivity rate of 95 percent and a specificity rate of 82 percent. Additionally, the study found the POC Advisor decreased lengths of stay by half a day in the ICU and reduced the 30-day readmission rate by about 30 percent. In the hospital units without the POC Advisor, researchers found no change in sepsis deaths pre- and post-study.

"If you look at the literature out there, no other system has ever done this," said Mr. Benson. "What you typically find is high sensitivity and low specificity or vice-versa."

He noted the POC Advisor targets specific patients at risk of sepsis hours before staff members would have otherwise noticed.

"We're trying to focus on areas where people, in general, aren't looking for sepsis immediately, where it's kind of a secondary consideration," explained Mr. Benson. "That's where we think we have the biggest opportunity in the near-term."

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