Becker's Clinical Quality & Infection Control

27 Executive Briefing VigiLanz Corporation (www.vigilanzcorp.com) is a privately held, rapidly growing digital health care firm. The company is a leading provider of real-time SaaS health care intelligence and predictive analytics, and is focused on aggregating disparate health system EMR transactional workflow and documentation data to identify clinical issues and avoid or minimize harm, optimize clinical outcomes and support preventive care along the entire health system continuum. The company was founded by David Goldsteen, M.D. and David Klass, M.D. in 2001. VigiLanz supports a large and growing community of hospital CMOs, CMIOs, CIOs, quality teams, infectious disease and control specialists, pharmacists, and other clinicians dedicated to real-time inpatient and outpatient care. VigiLanz is shaping the 21st century vision for real-time health care by delivering the right data, to the right people, at the right time and improving patient care and operational effectiveness. interventions included in the guidelines (measuring lactate, obtaining blood cultures and administering broad spectrum antibiotics) should occur within the first three hours of presentation of severe sepsis, while subsequent interventions (fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion and repeating lactate measurement) should occur within six hours of presentation of septic shock. Adhering to these timelines is critical for leveling the severity of septic shock and ultimately saving patients' lives, as well as reducing costs. In addition to following the prescribed timetable for administering septic interventions, it is also important to address the various measures outlined by the Severe Sepsis and Septic Shock Early Management Bundle. When all aspects of a bundled or composite measure are performed collectively, it makes each of those elements more impactful than if they were performed separately, according to Ms. Pur. However, the challenge for hospitals is ensuring 100 percent compliance with the measure, because not following every indicated bundle element for each patient with septic shock constitutes an error. "If one measure is not performed, the bundle fails," says Ms. Pur. "If there is not 100 percent compliance, there is zero compliance." Identifying Patients at Risk for Sepsis — Right Away Early intervention is critical for treating sepsis, but this is not easy; clinicians are challenged to identify the condition against the backdrop of the patient's existing infectious illness and comorbidities. Often, by the time sepsis is identified, it's too late to treat. What if clinicians could identify which patients were at risk for sepsis before they even walked through the hospital doors? With predictive analytics, deriving such insight is possible. While real-time analytics enhance clinicians' ability to detect sepsis at the earliest stage possible, predictive analytics help clinicians anticipate which patients are at the greatest risk of developing the disease before they get it, according to Ms. Pur. VigiLanz is constantly running thousands of real-time evidence-based rules to create a seamless, asynchronous umbrella over each organization to assure not only early identification of sepsis patients, but also additional alerting when key components of sepsis intervention have not been met, or have changed. A classic example is confirming not only that a broad spectrum antibiotic has been ordered, but also assuring that the right antibiotic has been selected. Today's sepsis challenges include a component of mandated reporting using concurrent review of the severe sepsis core measure. Automation is an integral component of streamlined concurrent review workflows. VigiLanz incorporates a high degree of automation not only around required elements for reporting, but also related to collecting data for special populations, intervention opportunities and analytical elements such as morbidity. "Automating the collection of sepsis-related data as much as possible eliminates the amount of [manual] abstraction needed," says Ms. Pur. Fighting Sepsis Requires Cultural Buy-In It is important to note that not all hospitals are alike, so when considering a new approach for combating sepsis, both hospitals and their third-party partners must keep culture, clinical workflow and business operations in mind. Cultural buy-in is a critical predictor of the success of any new initiative, as is physician trust. When taking an analytical approach to fight sepsis, clinical deficiencies may be exposed, but such areas of weakness present opportunities for learning. Enemies to cultural buy in include over-alerting and data gaps. "Because VigiLanz is able to leverage many disparate elements of the patient's electronic chart and work easily with data gaps and non-standardization issues, we are able to customize performance improvement efforts to the specific needs of individual hospital systems across the continuum of care," says Ms. Pur. Conclusion The fact alone that the number of people dying of sepsis in hospitals is rising is indication enough that the U.S. healthcare system is in great need of change regarding sepsis diagnosis and intervention. Furthermore, hospitals' financial health is on the line if they are unable to manage the problem effectively. With the new CMS bundle tying sepsis treatment to reimbursement, this financial impetus is even greater. As technology evolves and clinicians' and operations managers' capacity for using data insights proactively — instead of retrospectively — increases, hospitals can be empowered to take control and gain an edge in the fight against sepsis. With targeted real-time alerting, workflow automation and predictive analytics, clinicians can fulfill the IOM's guidelines for early and timely intervention as effectively as possible.

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