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Kathleen Merkley, DNP, APRN joined Health Catalyst in March 2013, as an Engagement Executive. Prior to coming to HC, she worked for Intermountain Healthcare as the corporate clinical IT implementation manager. Kathleen is a registered nurse/nurse practitioner and just received her doctorate in nursing practice from the University of Utah in May 2013.
Estimates place the in-hospital mortality for patients with COVID-19 between 15 and 25 percent, making early identification of individuals at high risk an imperative. Clinicians need reliable tools to identify individuals at the highest risk of severe deterioration. Risk-scoring tools exist for common acute conditions (such as septic, hypovolemic, or cardiogenic shock), but these methods don’t focus on COVID-19’s primary clinical impact—respiratory function. As a result, patients experiencing severe symptoms of COVID-19 may appear stable according to vital signs, such as heart rate and blood pressure, when they’re in fact critically ill. A more evolved approach to COVID-19 risk scoring focuses hypoxemia, or a below-normal blood oxygen level.
The CDC reports that one in three inpatient deaths is related to sepsis, with related health system costs totaling over $1.5 billion. Fortunately, nearly all sepsis deaths are preventable. However, most health systems lack the tools and information they need to steer sepsis improvement efforts that significantly reduce mortality rates.
Robust data infrastructure supports sepsis improvement teams by surfacing detailed data that reveals care gaps and missed opportunities. With access to sepsis data, improvement teams can implement five data-informed strategies that reduce sepsis deaths:
1. Create alerts for early detection.
2. Improve three-hour bundle compliance.
3. Optimize emergency department processes.
4. Leverage the CDC Sepsis Surveillance Toolkit.
5. Implement care transition processes to prevent sepsis readmission.
How can health systems avoid just talking about improvement and instead achieve real progress in clinical quality performance? First, improvement teams need access to a robust data infrastructure that can provide a complete picture of performance. This analytic insight reveals process gaps and opportunity areas where the care team can target improvement efforts.
After selecting an opportunity area, care teams are ready to follow the three-step process to achieve meaningful clinical improvement:
1. The “why”: Identify the outcome goal.
2. The “what”: Select a written, measurable, and time-sensitive process metric to evaluate the process.
3. The “how”: Identify the best interventions that will support the desired change in a process.
The traditional sepsis identification method—based on a combination of physician notes, coding, and billing—is often varied and too subjective, leading to inaccurate data. Because margins are tight and health systems can’t afford to waste any resources, clinical teams need to start with the most effective sepsis identification method. Using physiological data, such as vital signs, to identify sepsis is proving to be highly effective.
With the physiological data approach, providers rely on the body’s response—rather than being steered by biases, anecdotal information, or reimbursement rates—to more accurately identify patients with sepsis. With a more effective approach to sepsis identification, providers can implement interventions sooner, leading to better outcomes.
Improving patient satisfaction scores and the overall patient experience of care is a top priority for health systems. It’s a key quality domain in the CMS Hospital Value-Based Purchasing (VBP) Program (25 percent) and it’s an integral part of the IHI Triple Aim.
But, despite the fact that health systems realize the importance of improving the patient experience of care, they often use patient satisfaction as a driver for outcomes. This article challenges this notion, instead recommending that they use patient satisfaction as a balance measure; one of five key recommendations for improving the patient experience:
1. Use patient satisfaction as a balance measure—not a driver for outcomes.
2. Evaluate entire care teams—not individual providers.
3. Use healthcare analytics to understand and act on data.
4. Leverage innovative technology.
5. Improve employee engagement.
This article also explains why patient experience is so closely tied to quality of care, and why it’s a prime indicator of a healthcare organization’s overall health.