Becker's Clinical Quality & Infection Control

19 Executive Briefing Sponsored by: Allied Against Sepsis: 5 Qs With Amplifire CEO on Eliminating Clinical Misinformation S epsis occurs when the body's response to an infection causes a cascading inflammatory reaction throughout the body. Sepsis can affect multiple organ systems and is one of the most complicated syndromes clinicians face. Despite improvements in technology and care protocols, sepsis continues to occur in American healthcare settings at epidemic levels, with more than 1.5 million U.S. residents developing the condition each year according to the CDC. About 250,000 patients with sepsis die each year, and one in three people who die in the hospital have sepsis. Allied against sepsis Amplifire Healthcare Alliance — a provider of outcome-based learning solutions for health systems — sought to improve sepsis care among its members by identifying and addressing clinical misinformation held by clinicians across healthcare. Alliance members include Aurora, Colo.-based UCHealth and Children's Hospital Colorado, Salt Lake City-based Intermountain Healthcare, Boston-based Partners HealthCare and the Duke Infection Control Outreach Network, among others. Amplifire enlisted 23 healthcare organizations to recruit physicians and advanced practitioners from across disciplines, including hospital medicine, emergency medicine and critical care medicine. From mid-August through early October 2017, participating clinicians took an accredited, evidence- based, 31-question sepsis training course on Amplifire's learning platform. Amplifire measures not just knowledge, but confidence in that knowledge. Among 1,245 participants, the platform identified 7,795 instances when clinicians answered questions about sepsis confidently but were wrong. By the end of the course, all of this misinformation had been eliminated. Bob Burgin, Amplifire's CEO, spoke with Becker's about the Amplifire Healthcare Alliance and its sepsis initiative. Mr. Burgin has a long history in healthcare, including building and taking public the largest geriatric rehabilitation facility chain in the United States. Bob is one of the founding members of the Amplifire Healthcare Alliance, a collaboration of several of the largest and most advanced hospital systems in the United States. Through the use of Amplifire and other learning tools that promote effectiveness and efficiency, Bob unites members' commitment to improving patient care and reducing the incidence of avoidable harm. Note: Responses have been lightly edited for length and clarity. Question: This was the largest study of its kind. Why was it done? Bob Burgin: The Amplifire Healthcare Alliance is a group of large health systems that have come together to try and solve complex clinical problems currently facing healthcare. The idea of the alliance is to use a common platform to build high-end content and conduct clinical interventions at various membership locations. Instead of standard CME compliance training, our advanced platform focuses on knowledge engineering around clinical problems that can profoundly impact financial reimbursement for health systems. Unlike most training platforms, Amplifire incorporates highly evolved data analytics to provide insight into the problem areas. We blind and benchmark the data for the benefit of all the members and share the full studies across the Alliance. A total of 23 healthcare organizations participated, and the results were sent to all members. Q: What did you learn from this clinical intervention effort? BB: Sepsis is a unique beast in that it's complex to diagnose and the guidelines have been rapidly evolving, so not surprisingly there's a high degree of uncertainty about the right thing to do, as well as a high degree of misinformation among physicians. If you look more closely at the clinical issues, the study identified some meaningful problem areas. For example, one of the guidelines for treating sepsis is rapid administration of fluids. Fluid resuscitation is associated with a variety of side effects, because fluids move out of the bloodstream and into body cavities, where they can put pressure on organs. This effect is dramatically increased in septic patients, whose inflamed circulatory systems are extremely leaky. In one of our findings, roughly two-thirds of clinicians believed that a fluid bolus dissipates into the body over two hours or four hours. Actually, the process takes less than an hour and for severely septic patients it can be as short as 10 minutes. If you're monitoring organ failure that may be exacerbated by fluids, it matters how long it takes for fluids to flood the body compartments. This was one of about six clinical findings where two-thirds of clinicians had incorrect knowledge that created risk for patients. Other findings were also notable. Patients over the age of 85 are 30 times more likely to get sepsis than patients under HEALTHCARE ALLIANCE

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