Improving Outcomes for Sepsis Patients: 3 Key Solutions Proven to Help
For years, I’ve been using data to gain the critical insights I need to improve business operations. And while I think what I do is important, nowhere else does data seem more valuable than when clinicians use it to improve patient outcomes and save lives. Take, for example, sepsis. Health systems want to reduce sepsis for many reasons, including:
- Sepsis costs lives. According to a 2014 report from The Advisory Board, sepsis contributes to more than 17 percent of hospital deaths.
- Sepsis adds significant costs to care. The 2011 Healthcare Cost and Utilization Project (HCUP) report from the Agency for Healthcare Research and Quality identifies sepsis as the most expensive condition that hospitals treat, costing $20.3 billion in 2011 alone.
- High sepsis rates lead to financial penalties. CMS passed a new final rule under the hospital-acquired condition (HAC) reduction program to encourage providers to improve their postoperative sepsis care. The ruling, which took effect in October 2014, levies financial penalties on hospitals with high postoperative sepsis rates.
Finding ways to improve outcomes for sepsis patients is a high priority for health systems across the United States. But they face significant challenges as they grapple with the complexity of the disease. In specific, it’s difficult for providers to reliably diagnose the disease when it first presents. And then it’s challenging for providers to determine the effectiveness of their treatments, especially when they don’t have analytics tools to measure their interventions and adjust if needed.
Overcoming current challenges by becoming data-driven
Overcoming the challenges of identifying and treating patients that present with sepsis is possible. But to be effective, organizations need to make decisions based on insights from the data stored within their facilities. Becoming data-driven also means that workers of all backgrounds (such as clinicians, analysts, and administrators) use near real-time data from across the organization to develop improvement initiatives.
To become truly data-driven, three critical components must be included with any data strategy: an enterprise data warehouse, sophisticated analytics applications, and permanent teams. By combining all three of these critical elements, health systems will have a fully integrated, sophisticated solution that will enable them to achieve significant—and sustainable—gains in sepsis outcomes.
1. An enterprise data warehouse establishes a single source of truth for all data.
An enterprise data warehouse (EDW) is the heart and soul of a data-driven organization. An EDW’s ability to pull in data from many source systems (e.g., research, lab, registration, pathology, radiology, ambulatory surgery) and store all of that data in one central repository, provides the organization with a single source of truth. Using one central repository of data is advantageous because it eliminates the need for highly trained data analysts to manually track down the necessary data for the reports. The EDW also provides users with access to near real-time data because the platform is designed to pull raw data from each of the individual source systems. Having access to such high-quality data enables users to measure their improvement efforts and know if they’re making progress or not, and then adjust accordingly. Once adopted, the EDW becomes the foundation for sophisticated analytics applications.
How an EDW enabled a health system to improve staff compliance with sepsis assessment protocols
History and goals: A large medical center wanted to improve its nurses’ compliance for completing sepsis patients’ assessments. For three years, the organization had a sepsis assessment checklist that was paper-based. But they weren’t able to track how many nurses were completing the assessments.
Tactic: The health system implemented an EDW. The EDW served as a clinical, analytics, and process-based framework that enabled an enterprise-wide, consistent view of data from the EHR and all of the other source systems. After the organization adopted the EDW, it had the necessary foundation in place to add sophisticated analytics applications.
Early Results: The medical center realized an 80 percent relative increase in nurses’ compliance with completing assessments. This is because the organization can now track the data in the EDW to know if nurses are complying with process measures across with different units (e.g., lactate tests and administration of antibiotics), and track outcomes with sepsis mortality rates. Once full compliance is reached, clinicians will be able to tap into the insights from the assessments to identify early on patients who may be at risk for sepsis. Early identification will help clinicians act proactively against the disease and reduce the possibility of severe sepsis and/or septic shock. Such proactivity will help to improve outcomes. The health system’s goal is to ensure that screens are performed on each patient at the beginning and end of each nursing shift.
2. Sophisticated healthcare analytics applications identify the best improvement opportunities.
As the previous example shows, an EDW pulls in all of a health system’s core data into a single source of truth. Once that foundation is in place, the organization can then integrate sophisticated analytics applications on top of the EDW.
Analytics provide users with the ability to measure adherence to clinical best practices, minimize waste and reduce variability, and suggest improvements to individual patient care. What’s more, the data in an analytics application is presented in easy-to-understand visualizations that enable users to quickly grasp the data’s insight. Then users can drill down if they need more information to answer to their questions. This is all possible without the need for users to understand querying languages like SQL.
Take sepsis interventions for example. Users (physicians, nurses, managers) need to make queries, conduct research, track interventions, and analyze sepsis trends. Once they have the data from the EDW, they can identify variations in sepsis care delivery to target areas that need to be improved. They are also able to track the effectiveness of their interventions.
How a large medical center improved patient tracking by adopting a sepsis-specific analytics application
History and goals:The health system had been working on a sepsis program for three years. However, the system found it difficult to measure and analyze its compliance to evidence-based practice sepsis bundles and overall sepsis outcomes measures such as LOS, costs, sepsis rates, and mortality rates. As an important component of its commitment to deploying best practices, the organization had already implemented an EDW. The health system next wanted to leverage the EDW in its sepsis project.
Tactic: On top of the EDW platform, the organization deployed the Population Explorer Analytics Advanced Application—Sepsis Module. This analytics application enabled users to view a wide variety of metrics, including metrics about individual patient populations (such as case counts, readmission rates, charges, revenue, and length of stay). In addition, users could stratify any metric by demographic information and other clinical and financial information.
Outcomes: The organization created a sepsis registry and established a sepsis analytics program in a mere 10 weeks. This scalable platform—that can integrate clinical, financial, operational, and other data sources from a single source of truth—will enable the team to track interventions and the interventions’ impact on sepsis rates and financial measures.
3. Permanent cross-functional teams maintain sustainable sepsis improvements.
Even if a health system has an EDW and analytics applications, the organization may still struggle to maintain its gains over the long term. This is because oftentimes the organization will move to other improvement projects after it sees progress in one area. The solution is to form permanent cross-functional teams with stakeholders (such as a physician, a nurse, a few people from various operational roles, and technical staff) from throughout the organization. The team’s role is to remain accountable for monitoring sepsis improvements and for finding ongoing ways to increase gains.
How a health system reduced sepsis mortality rates by setting up permanent, integrated teams
History and goals: In 2012, MultiCare Health System prioritized the need to improve its sepsis rates because some of its facilities were performing below the national mortality averages. The organization had already installed an EDW along with clinical and process improvement services. It had also refined the clinical definition of sepsis. With help from a clinical implementation team and an analytics platform, MultiCare was able to reach a consensus on the definition of a septic patient.
Tactics: MultiCare established a system-wide critical care collaborative made up of permanent, integrated teams of clinicians, technologists, analysts, and quality personnel. The purpose of the collaborative was to address three concerns: standard of care definition, early identification, and efficient delivery of the defined care standard. Here’s how the team approached the challenge:
- Standardized evidence based practice sepsis order set. The team streamlined several sepsis order sets from across the organization into one system-wide standard for the care of severely septic patients. Now, adult patients presenting with sepsis receive the same care at all MultiCare hospitals.
- Early identification of sepsis patients. The team members worked with their developers to create a cohort definition using the clinical EMR data, enabling clinicians to quickly identify downwardly trending patients. Now, hospital staff members constantly monitor the cohort, which serves as an early detection tool for caregivers to provide preemptive interventions.
- Efficient delivery of care. The team’s final key piece of clinical work was to ensure efficient delivery of care to patients presenting with sepsis. Similar to other health system codes (e.g., code trauma, code neuro, code STEMI), “code sepsis” at MultiCare brings together essential caregivers who deliver time-sensitive, life-saving treatments to sepsis patients.
Outcomes: In just 12 months, MultiCare was able to reduce sepsis mortality rates by an average of 22 percent, which led to more than $1.3M in validated cost savings during that same period. The sepsis cost reductions and quality of care improvements have raised the expectation that similar results can be realized in other areas, such as heart failure, emergency department performance, and inpatient throughput.
Tackling sepsis with data to improve outcomes and decrease costs
Tackling sepsis is a major challenge for health systems. Despite the challenges, though, it’s critical that health systems find ways to decrease sepsis rates because high rates can have significant negative impacts on outcomes and greatly increase costs.
Without technological tools designed to work with a health system’s large amounts of data from various sources and permanent dedicated teams, efforts to improve sepsis outcomes will be crippled. Healthcare-specific solutions, such as an EDW and sophisticated analytics applications, will provide the means for healthcare workers to mine all of the key data sources necessary to discover areas for improvement. In addition, a collaborative, permanent team is also needed to make those significant improvements identified, use the analytics applications to conduct ongoing analysis of the effort, and monitor progress and compliance with best practices to ensure improved patient outcomes.
I’d love to hear from you. Are sepsis rates increasing at your health system? Have you had success finding improvement opportunities? If not, what solutions are you lacking?
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