Becker's Clinical Quality & Infection Control

12 PATIENT & CAREGIVER EXPERIENCE How Novant cut sepsis mortality in half — and why it's calling for policy change By Mackenzie Bean N ovant Health has achieved a more than 50% reduction in sepsis mortality across its hospitals since 2021, following coordinated efforts to improve early identification and treatment. e Winston-Salem, N.C.-based health system attributes this improvement in large part to its continued use of the Sepsis-2 criteria, which emphasize early, symptom-based detection. Although payers are increasingly aligned with Sepsis-3 — a 2016 framework centered on life-threatening organ dysfunction — Novant has found that such criteria oen delay intervention. By maintaining Sepsis-2 protocols, the health system has seen measurable gains in patient outcomes. Daniel Feinstein, MD, system physician executive for the Novant Health Hospital-Based Medicine Institute and co-director of systemwide sepsis care, recently spoke with Becker's about these clinical advancements and the policy shis needed to improve sepsis care at the state level. Editor's note: Responses have been lightly edited for length and clarity. Question: Novant Health has reported significant improvements in patient survival rates using the Sepsis-2 criteria. Can you share more about the system's decision to stick with Sepsis-2? Dr. Daniel Feinstein: e Sepsis-3 criteria came out in 2016 and were really touted as the new and improved quick assessment meant to facilitate early diagnosis. But in the end — and within our literature in medicine, critical care and hospital-based medicine journals — we found that Sepsis-3 criteria really reflect the terminal- or end-stages of sepsis. When someone has mental status changes, is breathing fast or their blood pressure is low, that's someone who's already very advanced in their sepsis event. at doesn't help us much, since it's so important to treat fast, which means identifying early. e Sepsis-2 criteria allow us to cast a wider net and identify patients early in their sepsis care. To take 20-plus hospitals and a bunch of clinicians and make changes as dramatic as we have is really remarkable. We've seen a greater than 50% reduction in mortality for sepsis patients. We use scoring systems to predict survival, and we found that, because of this work and using Sepsis-2 criteria for early identification, about 25 to 26 patients per month who were predicted not to survive their sepsis event are now surviving across the system. at's a testament to the collaboration and hard work. It all starts with identification — and with the proper definition. Q: What steps did you take at the system level to achieve early sepsis identification and consistency across hospitals? DF: Over the past several years, our system — all of our facilities working together with leaders and specialties involved in sepsis care — has fine-tuned processes, order sets and triaging. We focused heavily on triage. e second a patient comes through the emergency room, they're screened immediately. If they screen positive, they're brought to the clinical team without delay. We also emphasized rapid source control. For example, if someone needs surgical intervention for a perforation, they get it right away. Another big piece was creating a live data dashboard. is lets us monitor whether patients are getting the sepsis bundle elements (blood cultures, lactate levels, antibiotics, fluids) within the three- and six-hour windows. at level of accountability improved compliance and outcomes. Q: Beyond definitions, what role do technology and innovation play in how Novant is advancing sepsis care? DF: We use best practice advisories in the EHR to flag patients The states adopting the 'physician associate' title By Patsy Newitt T hree states have successfully made statutory changes to replace the title "physician assistant" with "physician associate," according to an Oct. 28 news release from the American Academy of Physician Associates. Here are five things to know: 1. In April, Oregon Gov. Tina Kotek signed legislation officially changing the title to "physician associate," making the state the first in the nation to do so. 2. In June, Maine became the second state to adopt the new title after two years of advocacy by the Maine Academy of Physician Associates. 3. In July, New Hampshire became the third state to pass legislation legally updating the title, following a bipartisan study committee that found the term "assistant" can create confusion about a PA's role and responsibilities. 4. On Oct. 22, the Ohio House Health Committee heard HB 353, a bill proposing to make the same title change. 5. The AAPA said in the release the title better captures the profession's training, autonomy and collaborative function in modern healthcare settings. n

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