Becker's Clinical Quality & Infection Control

20 Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. 7 Ideas for Improving Sepsis Management By Ellie Rizzo I n a healthcare world in which amazing things are increasingly possible — surgery through just a few tiny incisions, successful replacements of entire organs, treatment of once-fatal infections — sepsis is still a problem. Sepsis, a highly fatal immune system response to foreign bodies like bacteria, fungi and parasites in the blood, is actually on the rise. According to the Hospital Cost and Inpatient Utilization Project, sepsis as a primary diagnosis has grown 132 percent between 1997 and 2011. In 2011, the most recent year for which statistics are available, sepsis was the third most common primary diagnosis for inpatients in the United States. Why is sepsis so problematic? It's an interesting question. If sepsis is not caught early — which is difficult to do — the patient's condition can degenerate rapidly."It isn't strictly a technology issue," says Sean Benson, vice president of innovation at Wolters Kluwer Health-Clinical Solutions. Mr. Benson, Wolters Kluwer Health's in-house sepsis expert, says, "Sepsis is something that requires a cross-functional team to recognize and treat." Julie Kliger, BSN, MPA, founder/principal of The Altos Group, a healthcare consulting practice for change management, agrees sepsis management is a systems issue. Once it is diagnosed, workflow, or all the steps required to have some aspect of care delivered, can interfere with sepsis treatment. From prescription to antibiotic delivery, treat- Sepsis as a primary diagnosis has grown 132 percent between 1997 and 2011. In 2011, the most recent year for which statistics are available, sepsis was the third most common primary diagnosis for inpatients in the United States. ment is completed by many different actors. "By the time one activity has occurred, there might be a lag of a couple hours because everyone is doing their part in a vacuum," says Ms. Kliger. According to Mr. Benson, the chances of a sepsis patient's survival decrease 8 percent every hour when treatment is delayed. To improve sepsis care, Ms. Kliger says healthcare must focus on identifying the most important aspects of care delivery and must re-engineer for improved speed and reliability. Mr. Benson says hospitals should start with better data management and sepsis education. Additional recommendations from these experts to improve sepsis management include: 1. Focus intervention efforts on medicalsurgical floors. This is where patients start out stable, and sepsis can go unnoticed for dangerously long periods. Becker's Hospital Review 5th Annual Meeting May 15-17, 2014 • Swissôtel • Chicago, Illinois The Most Business- and QualityFocused Meeting in the Hospital and Health System Arena 100+ sessions and 190+ speakers Register by April 1 for Early Registration Discounts Keynote speakers include: Barry Arbuckle, PhD Joe Torre For more information visit, www.BeckersHospitalReview.com and click on "Conferences." Toby Cosgrove, MD Forrest Sawyer 2. Take advantage of data. Key data points in vital signs monitoring — such as heart rate and blood pressure thresholds — can drive early warning signs of sepsis, according to Mr. Benson. However, institutions first have to understand where they are starting in order to improve. Collecting baseline data is integral to monitoring process improvement, according to Ms. Kliger. 3. Improve data collection. Some hospitals already have large data collection systems in place. However, "organizations aren't really in a position to track sepsis data very carefully. They usually find their data isn't very good for various reasons," says Mr. Benson. He recommends setting specific data collection parameters to improve the quality of data available for decision-making. 4. Have organizational conversations before they come up in real time. Chat with infection preventionists and pharmacists to understand what key decisions in sepsis management can be streamlined to improve workflow. Teams working together during the sepsis treatment process should have encounter questions that are possible to answer at times other than the critical window for sepsis treatment. 5. Communicate in real time. Another way to reduce problematic time-lags from sepsis management teams is to encourage team members to take advantage of technology and communicate in real time. Instantaneous conversations mean faster treatment. 6. Build improvements with engagement components for medical staff. "The difficulty is appreciating [that improvements in sepsis care] will be a journey," says Ms. Kliger. Keeping medical staff motivated, when they already have so much on their respective plates, may mean the difference between life and death for some patients. 7. Focus on front-line staff. According to both Ms. Kliger and Mr. Benson, the front line is where improvement actually occurs. While small teams on the front line test new care and workflow processes, a steering committee should analyze data and results. Observations from the test teams helps the steering committee make better recommendations. n

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