Analytics, workflow and physician education aids sepsis care at Allina Health
Allina Health has developed a data-driven approach for early identification of sepsis, and the initiative also has reduced variations in sepsis care.
The organization, which operates 12 hospitals and 90 clinics in Minnesota and Wisconsin, is reporting an 18 percent drop in mortality for most sepsis patients and a 30 percent drop for the most severe cases, saving lives.
More than 1.5 million individuals in the United States are treated for sepsis each year, and one in four of them die. Patients who survive stay in the hospital much longer than many other patients with different illnesses. That’s why sepsis has become a top priority at Allina Health.
With 12 hospitals and 90 clinics in Minnesota and Wisconsin, Allina had screening tools and a sepsis alert system in its electronic health record, but they were not embedded in clinicians’ EHR workflows in the Epic electronic health records system, said Mischa Adams, clinical standard coordinator, during an interview at HIMSS19.
“We had 13 sepsis alerts in the EHR and turned to educating physicians to identify possible problems in their workflow,” she added. “We analyze data sets on patients who had sepsis and give doctors a monthly report on how they are caring for their patients so they can see where they may have missed a step or took an alternative approach.”
However, the organization still had many holes in its sepsis strategy. For example, when documented findings met the inclusion criteria for sepsis care, an alert was triggered but the nursing documentation for sepsis was in a different part of the EHR than the documentation that actually set off the alerts. That delayed quick identification and treatment.
One of the biggest problems was getting physician buy-in because while there were 14 different order sets for sepsis treatment the doctors did not use them because the order sets had not been updated as clinical guidelines changed.
Allina further is conducting data analytics using a platform from Health Catalyst, with sepsis-related analytics tools to help physicians making decisions at the bedside and also giving them cheat sheets on various metrics.
Subsequent improvements made in sepsis care include an 18 percent cut in mortality rate for all patients with sepsis, a 30 percent reduction in mortality for patients with severe sepsis and septic shock, and $1.1 million in savings for reduced length of stay, all while the number of sepsis-diagnosed patients increased by more than 30 percent, reflecting improvement in timely recognition of the disease.
Tips from Adams and Sarah Jenson include forming an interdisciplinary group comprised of physicians, nurses, lab directors, and pharmacists who regularly meet to discuss data and what it indicates; combining provider and patient specific data with clinical expertise to identify variations in care; and using data and sepsis analytics to measure performance of clinicians in adherence to bundles and their patient outcomes. Further, focused education on sepsis should be given to emergency department clinicians, inpatient nurses and other attending providers.