Licking Memorial Hospital (LMH) in Central Ohio faced a challenge familiar to many hospitals: how to reduce an alarming sepsis mortality rate. For CIO Sallie Arnett, who lost her dad to sepsis, the challenge hit home. The initiative that she and her team put in place has reduced sepsis mortality at LMH by 70%, saving more than 120 lives in its first two years of operation. “The reduction of sepsis related deaths is an area where we can really make a difference,” Sallie observed.
To be successful, LMH would have to tackle aspects of sepsis that make it the deadliest condition in U.S. hospitals. Onset can be subtle, and it can escalate rapidly. Early detection and treatment are critical, but symptoms are similar to less serious conditions. Physicians have to evaluate a number of factors to make an accurate diagnosis, and start treatment promptly in compliance with CMS treatment bundles. While their EHR system had some limited sepsis management capabilities, there were many false positives and minimal impact on patient outcomes. “It was a good start, but we knew we could do better,” Sallie said.
Transforming Sepsis Care
The team defined key requirements, including the ability to accurately detect sepsis in real time, send real-time alerts for at-risk patients, and leverage existing technology. To achieve these goals, they use iatricSystems Visual SmartBoardTM for Sepsis which provides 24×7 sepsis surveillance of all hospital inpatients. Color-coding in the application allows clinicians to quickly see each of the sepsis statuses at a glance, from negative through septic shock. Behind the scenes, the SmartBoard algorithm evaluates all relevant criteria (including vital signs, labs, problem lists, and clinician documentation), and classifies patients by sepsis stage in real time. The algorithm is finely tuned: in a 3-month LMH study, the SmartBoard detected sepsis, severe sepsis, and septic shock with 100% accuracy.
“Visual SmartBoard takes a huge burden off our front-line staff,” says Heather Burkhart, Vice President Acute Care Services. “It helps us identify sepsis patients much sooner and stop their progression to severe sepsis and septic shock.” The ability to aggregate information from multiple IT systems and evaluate it in real time has transformed sepsis care at LMH, enabling earlier detection and treatment. Rather than gathering information manually, clinicians simply log on to the SmartBoard for an overview of each patient and their sepsis status, and then can drill down for details. “There’s a huge amount of data available,” Sallie noted. “We’re capturing it, collapsing it, and making it very easy for care providers to view.”
Real-Time Alerts and Managed Interventions
Real-time physician alerts are another key element for positive outcomes, leveraging messaging technology in place at LMH. The Sepsis Visual SmartBoard integrates with the Hospital’s Imprivata® Cortext® secure texting platform to alert physicians on their smart phones when a patient meets CMS criteria for severe sepsis or septic shock. (Nurses receive a similar alert on their status board.) Visual SmartBoard then tracks required interventions to make sure these occur within critical three and six-hour time windows, and reminds the physician to document their re-assessment on the Sepsis Progress Note after the fluid bolus is completed.
Improvement Numbers—and the Lives behind Them
Since going live, sepsis mortality at LMH has plunged—from 27.1% to 8.9% in 2016 (the first full year of data). The improvements have been sustained, holding steady at 9% through 2017 and into 2018. Beyond these dry percentages are much more meaningful numbers: 62 lives saved in 2016, and an additional 59 lives saved in 2017. “A lot more people are able to go home to their families,” Sallie says. “At the end of the day, that’s why we’re in this business.”