Meet SPOT: HCA Healthcare's 'smoke detector' for sepsis

Nashville, Tenn.-based HCA Healthcare is sounding the alarm when it comes to sepsis.

In 2018, the health system rolled out Sepsis Prediction and Optimization of Therapy, an algorithm-driven, real-time sepsis alert system. At present, 154 of HCA's 185 affiliated hospitals are using SPOT, and the efforts are paying off. HCA clinicians can now detect sepsis up to 18 hours sooner.

"The combination of our efforts through the Surviving Sepsis Campaign from 2013-17, plus the implementation of SPOT in 2018, has saved approximately 8,000 lives," said Jonathan Perlin, MD, PhD, CMO and president of clinical services at HCA Healthcare.

Dr. Perlin spoke with Becker's Hospital Review about the new sepsis alert system, along with some of HCA's other quality improvement efforts.

Editor's note: Responses have been lightly edited for length and clarity.

Question: How does SPOT help HCA clinicians detect sepsis earlier?

Dr. Jonathan Perlin: SPOT helps HCA Healthcare clinicians essentially do the impossible; it allows them to simultaneously be at the bedside giving care while also being completely aware of every new piece of lab data that defines sepsis.

The traditional approach to treating sepsis is to first recognize the warning signs, which is akin to recognizing a fire when flames are shooting out of a building. We built SPOT to be a smoke detector for sepsis. It monitors the computer 24 hours a day, seven days a week, 365 days a year to "sniff out" the first signals of sepsis. When those signals fulfill the criteria for sepsis, they are presented to our clinicians at the bedside, who will react immediately. Every hour of delayed diagnosis results in up to an 8 percent increase in sepsis mortality. With SPOT, we are able to get somewhere between five and 18 hours of earlier lead time on sepsis and, in the process, save lives.

Q: How did you ensure staff members were on board with the new technology and used SPOT correctly?

JP: For an artificial intelligence model to have uptake, it has to be both credible and explainable. SPOT is extremely reliable and has very few false positives. In fact, it is more than 50 percent more accurate at excluding patients who don't have sepsis than even the best clinician. So that's the credible part. Let me flip to the explainable part. We incorporated SPOT into the workflow in a way that allows the clinicians to see what the computer sees. So rather than saying, "This patient has sepsis," SPOT shows clinicians the criteria for sepsis and the patient's criteria, allowing them to come to their own conclusion.

We're really excited that our coalition has loved using SPOT. Clinicians have told me it's sort of a repayment for all the effort they put into using the EHR. SPOT allows that data to come full circle. The data are captured at the bedside, placed in our data warehouse and then used as decision support, ultimately getting passed back to the bedside to improve care. This is really the definition of a learning health system, and our information infrastructure is meant to allow for that. This process can improve the care of any given patient in real time, as well as improve the knowledge and learning that make both the system and the knowledge base for healthcare better.

Q: What other clinical applications is HCA planning to use machine learning for?

JP: Ten years ago, we decided that we wouldn't just rip out and replace our information system for a slightly prettier one. We wanted to create an information architecture that would be a learning health system, which is predicated on the ability to learn at speed and at scale based on approximately 31 million patient encounters every year. We've brought together our incredible team of IT colleagues and our clinical services group to address our most important problems, which includes sepsis.

Other areas we're interested in using machine learning relate to the surveillance and quick detection of any type of patient deterioration, so that we can offer the safest, most compassionate care environments possible, while also contributing to the general understanding of disease and the improvement of treatment.

Q: If you could fix one patient safety issue overnight, what would it be?

JP: This takes me back to the roots of quality. If I could improve one thing around the country and world, it would be hand hygiene. Sometimes it's not about the big gains, but the little things that every caregiver and family member does that can affect patients. It's often said that if healthcare could be as vigilant about hand hygiene as cruise ships, we'd save many lives.

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