UCHealth gets ag­gres­sive to re­duce sep­sis mor­tal­ity by 15%

Modern Healthcare - - BEST PRACTICES - By Maria Castel­lucci

When lead­ers at Den­ver-based Univer­sity of Colorado Health saw last year that 10% of pa­tients with sep­sis died from the con­di­tion, they acted quickly to root out the prob­lem.

The sys­tem con­ducted a study of sep­sis pa­tients and found that it was tak­ing too long to get their the an­tibi­otics they needed to stop the in­fec­tion be­fore it be­came life-threat­en­ing.

The CMS core measure re­quires that an­tibi­otics be ad­min­is­tered within three hours of a pa­tient pre­sent­ing with signs of sep­sis. At UCHealth, pa­tients of­ten waited three hours or longer.

If pa­tients re­ceived an­tibi­otics within one hour of be­ing di­ag­nosed with sep­sis, the mor­tal­ity rate would de­cline by 50%, the study found.

“The big­gest pre­dic­tor of mor­tal­ity in our sep­sis pa­tients was tim­ing of an­tibi­otics,” said Dr. Jef­frey Glasheen, chief qual­ity of­fi­cer of UCHealth.

Armed with that in­for­ma­tion, front­line staff mem­bers were asked to come up with ways to en­sure pa­tients di­ag­nosed with sep­sis re­ceived an­tibi­otics in less than 60 min­utes. Their ideas cul­mi­nated in a mul­ti­step process that was im­ple­mented in Jan­uary at Univer­sity of Colorado Hos­pi­tal, UCHealth's flag­ship fa­cil­ity.

The ef­forts have since paid off, re­sult­ing in a 15% de­cline in the sep­sis mor­tal­ity rate, or 39 lives saved, at the hos­pi­tal so far this year.

The first step in the process is us­ing the sys­tem's elec­tronic health record to iden­tify pa­tients who might be sep­tic. The EHR alerts the nurse if a pa­tient has ab­nor­mal vi­tal signs and prompts them to check for other symp­toms that usu­ally in­di­cate sep­sis, such as the pa­tient be­ing dis­ori­ented or hav­ing dete- ri­o­rated kid­ney func­tion.

Al­though nurses are al­ready mon­i­tor­ing their pa­tients' vi­tal signs for ab­nor­mal­i­ties, the EHR alert en­sures sep­sis is top of mind, said Dr. Read Pierce, physi­cian co-chair of the sep­sis steer­ing com­mit­tee at Univer­sity of Colorado Hos­pi­tal. About 70% of UCHealth pa­tients with sep­sis are sep­tic upon ad­mis­sion.

Based on their other symp­toms, the EHR in­di­cates whether or not the pa­tient has a low, medium or high prob- abil­ity of sep­sis. For those de­ter­mined to have a medium or high chance of hav­ing the con­di­tion, the nurse then is prompted to call in the sep­sis team.

The team—a group of care­givers ded­i­cated to giv­ing a quick di­ag­no­sis 24/7—was formed at Univer­sity of Colorado Hos­pi­tal as part of the ef­fort. It in­cludes a nurse, a phar­ma­cist and a physi­cian or ad­vanced prac­ti­tioner. If they de­cide the pa­tient is sep­tic, an­tibi­otics are or­dered im­me­di­ately. The pre­scrip­tion or­der is marked ur­gent so the phar­macy has it ready in less than an hour.

A work­flow check­list for nurses was also cre­ated to en­sure they have the sup­port from the sep­sis team to ad­min­is­ter an­tibi­otics once they are ready for the pa­tient.

Since Jan­uary, the time it takes for sep­tic pa­tients to re­ceive an­tibi­otics has short­ened from more than three hours to roughly 75 min­utes. That's still 15 min­utes more than UCHealth's orig­i­nal goal, but Pierce is con­fi­dent that the sys­tem will get there soon. The ef­fort has a lot of staff buy-in be­cause they are in­spired by the pos­i­tive re­sults, he said.

Glasheen said a bonus is the ef­fort doesn't re­quire too much in­volve­ment from physi­cians and nurses; phar­ma­cists han­dle the bulk of the pro­cesses. “We didn’t have to train 2,000 physi­cians,” he said.

The ef­fort has also con­trib­uted to an 11% de­cline in length of stay in the in­ten­sive-care units.

“By rec­og­niz­ing sep­sis sooner and get­ting peo­ple an­tibi­otics sooner, they have go to ICU much less fre­quently and for much less time,” Pierce said.

The EHR sep­sis alert has now been im­ple­mented across all UCHealth hos­pi­tals, and been cus­tom­ized for each fa­cil­ity, Glasheen said.

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