Becker's Clinical Quality & Infection Control

47 QUALITY IMPROVEMENT & MEASUREMENT New York's sepsis treatment mandate linked to lower in-hospital mortality By Megan Knowles W hen hospital staff completes a series of clinical sepsis treatments and tests within an hour of its detection, hospi- talized pediatric patients' chances of survival sig- nificantly rise, a study published in JAMA found. e study, led by researchers at the University of Pittsburgh School of Medicine, looked at the outcomes of 1,179 children with sepsis at 54 New York hospitals. About 44 percent of the children were healthy before developing sepsis, and 139 patients died. Completion of the sepsis protocol within one hour decreased the odds of death by 40 percent. When only parts of the protocol were completed within an hour — for example, giving fluids but not testing for infection or giving antibiotics — the patients did not fare better. e finding held only if the entire protocol was completed in an hour. The study findings support a New York state mandate implemented in 2013 called Rory's Regulations, named after 12-year-old patient Rory Staunton, who died from undiagnosed sepsis in 2012. Rory's Regulations require every New York hospital to follow evidence-based clinical practice protocols for identifying and managing sepsis in a timely matter. "It's clear that completing the entire sepsis protocol within an hour is associated with lower mortality," said lead author Idris V.R. Evans, MD, in a news release. "But the mechanism of benefit still requires more study." Testing the sepsis protocol in future randomized clinical trials will present difficulties, the research- ers said. It would require some protocol elements being le off for certain septic children, but not others, in a random way, a design not currently aligned with the standard of care. But if more states adopt regulations like New York's, while mandating data reporting, fu- ture work could expand on these results, the researchers said. n How a Lean-based QI program increased discharges by noon By Anuja Vaidya A study published in The Joint Commission Journal on Quality and Patient Safety examined the effectiveness of a Lean Six Sigma-based quality improvement program on timing of patient discharge. For the study, researchers created a 'value team' at a 627-bed tertiary care academic medical center. They implemented a quality improve- ment project using Lean Six Sigma methodology. The project involved the team defining the problems around time- liness of discharge and then going through the steps in the Define, Measure, Analyze, Improve, Control framework. They then imple- mented interventions based on an in-depth analysis of barriers to the discharge process. The interventions included geographic cohorts of internal medicine physicians on specific hospital units and multidisci- plinary huddles one day before anticipated discharge. The study showed the percentage of discharge orders released by 10 a.m. increased by 21.3 points postintervention, and the per- centage of patients discharged by noon increased by 7.5 points. There were no significant changes in the 30-day readmission rate or length of stay. n Study: Outpatient follow-up visits linked to fewer hospital readmissions By Harrison Cook W ith mixed conclusions regarding the direct effect of outpa- tient follow-up care and readmission rates, researchers at Downers Grove, Ill.-based Advocate Health Care conducted a study to establish the link between outpatient follow-up care and hospital readmissions, according to a study published in PLOS One. Here are five things to know: 1. For the study, researchers analyzed data on 55,378 adult inpatients at Advocate who were discharged to their own home — some with home health services — between June 1, 2013, and April 30, 2015. 2. Within 30 days, 47.74 percent of patients had at least one follow-up visit. Also within those 30 days, 1,929 patients were readmitted, gener- ating a readmission rate of 7.30 percent. 3. Patients who followed up with their healthcare provider within two days of their release had the greatest reduction in readmission rate. 4. The longer patients waited to be seen, the greater the chance of experiencing a readmission. 5. Patients were more likely to have a two-day follow-up visit if the appointment was scheduled before they were discharged. n

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