A recent success story illustrates the power of IT and a coordinated plan to deal with sepsis at University of Utah Health.
The patient was admitted for hypoxia and fatigue, and by the next day, he had his first fever and registered a modified early warning system (MEWS) score of 8. Sepsis protocol was initiated to alert the rapid response team, and the provider was at the bedside within just seven minutes after the alert. Within 20 minutes, lactate and blood cultures were collected, and fluids and antibiotics were infused in less than an hour. The patient improved over the next few days and was eventually discharged.
This sepsis management success story is just one of many examples of University of Utah Health’s work to improve outcomes and reduce costs. Part of that work has centered on combating sepsis, a leading cause of death in the U.S.—and the most common cause of death among critically ill patients in noncoronary intensive care units. Additionally, sepsis is incredibly expensive for hospitals: The Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing nearly $24 billion to treat in 2013.
Sepsis can be successfully treated—the challenge for hospitals is identifying it and responding quickly. The risk of death from sepsis increases by 7.6 percent with every hour that passes before treatment begins. University of Utah Health launched an initiative to improve sepsis response in early 2016.
“This project came out of an interest in improving sepsis mortality by recognizing sepsis status more quickly, then rallying the right team to get those patients evaluated,” explains Kencee Graves, MD, an internist and assistant professor of internal medicine at University of Utah Health and co-director of the sepsis initiative. “Getting people to act faster has a huge amount of value, especially when you’re talking about sepsis—we wanted to get providers to the bedside in minutes every single time that sepsis is recognized.”
University of Utah Health’s sepsis workflow used to look like this—the nurse or nursing assistant would enter vitals into the EHR and make a judgment call about the patient’s condition if the vitals were out of range. Then, they would have to decide if they should manually page a message to the rapid response team asking for assistance.
Graves and her colleague, Devin Horton, MD, a hospitalist and assistant professor in the division of internal medicine, saw an opportunity to eliminate steps and minutes from this workflow with technology.
Graves and Horton realized they could use existing systems to hardwire sepsis alerts, automating steps within the recognition and communication processes in the sepsis response workflow. They used a Best Practice Alert (BPA) within the Epic EHR system to trigger the MEWS score alert, which was then automatically sent to the rapid response team via Spok, its healthcare communications platform.
Through the integration of the EHR system’s alert with the communication system, the MEWS alert is automatically sent as a message to either the charge nurse (if the MEWS score is less than 7) or to the rapid response team (if the MEWS score is 7 or more). The recipients then receive that notification on their mobile device to evaluate that patient for sepsis right away.
“The alert automatically goes from Epic to the charge nurse or rapid response team, via page” says Horton. “When you can automate the protocol, it just works.”
University of Utah Health implemented the new process in its acute care units in May 2016 and began seeing results. From May through December 2016, mortality rates for most MEWS scores began to improve. However, they realized that even people with lower MEWS scores would benefit from the rapid response team protocol. Originally, Graves and Horton had set the protocol to alert the rapid response team for a MEWS score of 8 or above, but then adjusted it to 7 and above instead. This step, along with more time using the new process, indicates promising results. In preliminary analysis, there was a mortality reduction of 20 percent for MEWS scores of 7 to 11 from pre- to post-implementation.
Ongoing analysis will be done to test for significance, but the early success has been enough to launch the new workflow hospital-wide. “The bottom line is that this streamlined sepsis response workflow has really helped our patients,” Graves says. “The data, and the anecdotal stories we’ve consistently heard from clinicians, illustrate that this process aids care team collaboration and gets patients the treatment they need.”
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