Improving Identification of Hospitalized Patients with Sepsis

Patients who are diagnosed with sepsis present on admission (POA) account for nearly 85 percent of cases. However, outcomes for patients with sepsis not on arrival (NPOA) are poorer due to higher acuity of the sepsis at the time of diagnosis. Because of the challenge associated with the early identification of sepsis for hospitalized patients, those with sepsis NPOA have a mortality rate as high as 35 percent, making outcome improvements for this patient population a top priority for hospitals.
Mission Health, a comprehensive healthcare system located in Asheville, North Carolina, sees the early identification of sepsis as a key part of achieving its goal of providing exceptional patient care. However, Mission lacked a mechanism to assist the clinicians in differentiating between sepsis and the patient’s acute illness, making the early diagnosis of sepsis challenging, negatively impacting outcomes. With the help of data analytics, Mission was able to gain a comprehensive view of sepsis outcomes, so that improvement efforts that help clinicians identify and provide early intervention for patients who may be septic could be effectively implemented and sustained.
Results:

45.3 percent relative reduction in severe sepsis and septic shock NPOA mortality rate.
14.4 percent relative reduction in length of stay for patients with severe sepsis and septic shock NPOA.

Optimizing Sepsis Care Improves Early Recognition and Outcomes

Early identification of sepsis is challenging, as the patient’s physical response to this overwhelming infection presents as a syndrome of non-specific symptoms, delaying recognition, diagnosis, and treatment, which increases mortality rates.
Mission Health, North Carolina’s sixth largest health system, had implemented evidence-based sepsis care bundles; however, processes for identifying patients with sepsis and initiation of care was fragmented and varied widely across the system, negatively impacting sepsis outcomes.
Using a comprehensive data-driven approach to facilitate early sepsis identification and standardize the treatment of sepsis, including the addition of evidence-based alerts, Mission has gained insight into sepsis performance to drive improvement. This approach has resulted in:

14.1 percent relative reduction in mortality for patients with severe sepsis and septic shock.
24.9 percent relative difference in mortality for patients that received the evidence-based protocols compared to those who did not—the evidence-based protocols substantially reduce mortality.
6.4 percent relative reduction in emergency department (ED) length of stay (LOS) for patients with severe sepsis and septic shock.
Four percent relative reduction in ICU LOS for patients with severe sepsis and septic shock admitted from the ED.

Reducing Sepsis Mortality and LOS with Improved Recognition and Treatment Protocols

In the U.S., over 1.5 million people are treated for sepsis annually. One in four people with sepsis die, making improving early identification and providing patients with timely treatment a top priority. Hospitals and health systems continue to look to improve outcomes for patients with sepsis.
Allina Health, a not-for-profit healthcare system of 12 hospitals and 90 clinics, all serving patients throughout Minnesota and western Wisconsin, previously implemented a rapid process improvement project using a three-part bundle focused on the early identification of sepsis. However, sepsis mortality rates remained higher than desired. After turning to an analytics platform to replace its burdensome manual review process, Allina Health was able to identify opportunities for improvement and develop evidence-based processes for sepsis identification and treatment.
Results:

18.6 percent relative reduction in mortality rate and 10.9 percent relative reduction in hospital length of stay (LOS) for all patients with sepsis.
30.3 percent relative reduction in mortality rate and 18.4 percent relative reduction in hospital LOS for patients with severe sepsis and septic shock.
$1.1 million in annual cost savings, the result of efficiencies and substantial reductions in hospital LOS for patients with severe sepsis or septic shock.

Evidence-Based Care Standardization Reduces Pneumonia Mortality Rates and LOS

Patients with pneumonia account for over 400 thousand emergency room visits, nearly 1.1 million inpatient hospitalizations, and more than 5.7 million inpatient days each year in the U.S. Every year, almost 51,000 patients die from pneumonia. Among the elderly, community-acquired pneumonia is an increasing problem, now ranking as the fourth leading cause of death.
Piedmont Healthcare, a not-for-profit integrated health system serving Georgia, had multiple order sets for disease management, but the health system lacked a uniform care pathway for the treatment of pneumonia. Care provided for the treatment of pneumonia was often not in alignment with evidence-based guidelines, such as antibiotic selections. This lack of consistency increased both LOS and cost, and a lack of case-specific data made the development of a uniform best practice for pneumonia treatment challenging. By accessing detailed case data with the help of analytics, Piedmont was able to identify and develop best practices for the treatment of pneumonia, driving out the variation that increased costs and reduced the overall quality of care.
Results:

56.5 percent relative reduction in pneumonia mortality rate.
$220,000 in savings over one year, the result of a 9.3 percent relative reduction in LOS.

Collaborative, Data-Driven Approach Reduces Sepsis Mortality by 54 Percent

In the U.S., sepsis impacts more than 1.5 million people annually, of which about 250,000 will die. This accounts for one-third to one-half of all deaths for hospitalized patients. Health Quest focused on identifying ways to improve these outcomes. Despite instituting several evidence-based recommendations, the organization had not succeeded in reducing sepsis mortality to its desired rate.
Health Quest established a multidisciplinary sepsis committee to lead improvement efforts, including the use of analytics to combat sepsis mortality rates and improve patient outcomes, resulting in a:

54 percent relative reduction in sepsis mortality, saving 92 lives in 10 months.
57.1 percent relative reduction in catheter-associated urinary tract infection (CAUTI) standardized infection ratio (SIR).
30.7 percent relative reduction in C. difficile SIR.

Successfully Sustaining Sepsis Outcomes

Increasingly, high-functioning healthcare organizations are recognizing the challenge of sustaining results following successful clinical improvement initiatives. Sepsis is a major driver of mortality in the U.S. In fact, it is estimated that up to half of all hospital deaths are linked to sepsis. After executing a successful strategy to improve outcomes for patients with sepsis, Piedmont Healthcare was determined to sustain those critical reductions in mortality, length of stay, and cost.
The health system “hardwired” process changes into the EHR, monitored performance compliance via a well-developed analytics application, and fostered strong leadership on the frontlines to champion a culture of continuous improvement. In the second year of its latest sepsis improvement effort, Piedmont was able to not only sustain, but also to further improve upon its first-year improvement results.
Second-year results:

14.2 percent reduction in mortality for severe sepsis and septic shock translating to 68 lives saved in one year.
30.7 percent improvement in number of patients receiving calculated fluid target.
$1.2 million saved in one year from decreased variable cost.

Integrated Care Management—Improves Care and Population Health While Reducing Costs

One hundred thirty-three million Americans, 45 percent of the population, have at least one chronic disease. Chronic diseases are responsible for 7 of 10 deaths each year, killing more than 1.7 million Americans annually. Moreover, chronic disease accounts for 86 percent of our nation’s healthcare costs.
An integrated delivery system and an accountable care organization with two large academic medical centers and six community hospitals, Partners HealthCare is increasingly compensated for outcomes of care. Recognizing the need to more effectively manage its chronically ill patients, Partners implemented an integrated care management program (iCMP) to improve the outcomes of rising-risk patients and better manage treatment costs. The iCMP is a primary-care embedded, longitudinal care management program led by a nurse care manager working collaboratively with the primary care provider and care team.
The iCMP is contributing to Partners effective management of patients and financial success in at-risk contracts. In its Pilot Phase as a Medicare Demonstration Project, the program achieved the following results:

20 percent lower hospitalization rate per 1,000 patients.
13 percent lower rates of emergency department (ED) utilization.
25 percent relative difference in mortality.

From the Boardroom to the Bedside—Using Analytics to Drive a Culture of Continuous Improvement

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.
Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.
Results:

20 percent improvement in compliance with severe sepsis; 32 percent reduction in mortality rates; 58 percent increase in sepsis detection.
7 percent reduction in LOS for bowel surgery patients.
34 percent improvement in heart failure LVEF assessment rates.
20 percent increase in “on time” starts as result of OR dashboard.

Using Value to Prioritize and Guide Analytics Investments

With the advent of analytics, hospitals have new access to high quality, reliable data. In turn, this can fuel any number of outcomes improvement projects, but hospitals have finite resources to expend on these initiatives. A process is needed to identify which ones will deliver the highest value and best align with the hospital’s overarching priorities.
To balance the demand for analytics support of improvement projects Mission Health designed a prioritization tool that has helped them identify the right projects to approve–while keeping stakeholders more engaged than ever in improving outcomes for patients.
To date, 80 percent of 55 approved projects have met or exceeded their initial targets. Actual realized targets include:

32 percent reduction in sepsis mortality
20 percent improved compliance with the sepsis care process
7 percent reduction in LOS for bowel surgery patients

How to Significantly Reduce Sepsis Mortality

Up to 50 percent of all hospital deaths in the United States are linked to sepsis. That sepsis mortality statistic was not lost on Piedmont Healthcare, a system of six hospitals and more than 100 physician and specialist offices across greater Atlanta and North Georgia. Sepsis accounted for half of Piedmont’s mortality rate, despite years of progress in sepsis care.
Piedmont leaders recognized that they needed an innovative quality improvement methodology to spread best practices and sustain improvement, supported by an accessible source of timely, reliable, and actionable information. They therefore implemented a “core and spread” team structure to promote enterprise-wide adoption of best practices. The health system also deployed a sepsis prevention analytics application to deliver performance insight to all levels of the organization, and discovered a high correlation between better patient and financial outcomes and the number of bundle elements the patient received.  Being able to tie outcomes to interventions, along with the incorporation of nurse driven protocols, resulted in sustained practice change and greater engagement from physicians, nursing and frontline staff, all the way to the Board level.
As a result, Piedmont achieved the following impressive outcomes:

5.8 percent reduction in mortality for all patients with severe sepsis and septic shock, translating to 26 lives saved in one year.
2.5 percent reduction in total inpatient length of stay (LOS).
8.2 percent reduction in variable cost per case, equating to $4.3 million saved in one year.

Evidence-Based Care Process Model Reduces SSIs and Readmissions

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.
In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.
Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.
Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

92 percent reduction in colorectal surgery SSI rates
28.5 percent reduction in mortality
10.6 percent reduction in 30-day readmissions
4.4 percent reduction in LOS
8.5 percent reduction in cost per case

Sepsis: The Impact of Timely, Trustworthy Data and a Systemwide Approach to Care Improvement

For patients with the severest form of sepsis, the chance of survival decreases by 7.6 percent for every hour that antimicrobial treatment is delayed. Coordinated team work and the speed with which recognition, diagnosis, and treatment of sepsis occur are critical. Health systems across the country have discovered that by successfully engaging clinicians in driving and maintaining best practice interventions they are able to save lives and improve patient outcomes. At Piedmont Healthcare, the work of educating clinicians on the importance of following sepsis care best practices had been done. The missing pieces were a well-resourced, systemwide improvement team to improve sepsis care, and a concise way to view and give timely feedback on performance based on accurate, trusted data. To fill in these missing pieces, Piedmont created a cross-representative sepsis improvement team and enabled tracking for compliance to best practices with an analytics application from Health Catalyst. Within just three months of deploying the Sepsis Improvement Application, Piedmont has accomplished significant improvements in efficiency—and completely won trust in the data. Piedmont has already identified early indications of patient outcome improvements. Initial achievements of its sepsis improvement team include deploying systemwide visibility into sepsis care performance and best practices compliance, improved acknowledgement of first alert by 19 percent across the system, and a reduction in manual data collection by 97 percent.

Care Management Strategy Improves Lives of Stroke Patients

Stroke is a leading cause of hospitalizations among elderly often resulting in serious long-term disability, readmissions (up to 27% are readmitted to the hospital in year one), or secondary stroke. Allina Health’s Courage Kenny Rehabilitation Institute (CKRI) had deployed a successful care coordination model for other complicated, high-risk populations that it was confident would help stroke patients, as well.
CKRI created a holistic program for stroke patients that delivers comprehensive, seamless care across inpatient, outpatient and support services. A data warehouse and analytics platform merges data across the care continuum, and enables Allina to target high-risk stroke patients for coordinated care, track their progress and measure their outcomes.
Within a year, Allina was able to prove the value of this new care model for stroke by realizing $350,000 in cost savings and, most importantly, through actual lives saved and improved.

Saving Lives with Best Practices and Improvements in Sepsis Care

Every year, severe sepsis impacts more than 1 million Americans, and an estimated 25 percent die from the condition. Thibodaux Regional Medical Center is committed to driving and keeping its sepsis mortality rate to less than have the national average. How is this health system achieving these outcomes? Thibodaux formed a sepsis improvement team charged with reducing sepsis mortality and lowering costs while improving the patient experience. The team implemented best-practice care protocols, an analytics system, and an adoption approach that engaged clinicians using education and data. Backed by executive leadership and guided by clear goals, the sepsis improvement initiative has achieved impressive results in just six months that include a decrease in sepsis mortality rate to half of the national average, a 3 percent reduction in average variable cost, a reduction in LOS in the ICU by one day, and a 7 percent improvement in patient satisfaction.

One Healthcare System’s Effective Strategy to Improve Pneumonia Outcomes

MultiCare Health System, an IDS serving communities throughout Washington State, recently undertook an initiative to improve the care of, cost of, and experience for pneumonia patients. This initiative included the building of evidenced-based order sets (and driving their adoption), assigning a team of social workers called “personal health partners” to research and improve patient follow-up and communication, and deploying an analytics application to provide near real-time feedback on compliance and performance while offering a single view of patient-specific data across multiple visits and care settings, such as medication and readmission histories. Through these efforts, MultiCare has realized significant outcome improvements including reducing pneumonia readmissions by 23 percent, a 28 percent reduction in mortality rate, a 2 percent decrease in LOS, and a 6.4 percent reduction in average variable cost per patient.

How an IDS Improves Outcomes Using a Clinical Collaborative Structure

MultiCare, an integrated delivery system (IDS) in the Pacific Northwest, has established a Clinically Integrated Network (CIN) to serve as a model for value creation that benefits patients, providers, and payers. However, to create a truly integrated network, MultiCare needed to build a system of collaboratives—multidisciplinary, clinically focused teams charged with developing clinical care standards and pathways and then collaborating with operations to get them implemented across the enterprise—to improve outcomes in a growing range of clinical domains including Critical Care, Women’s, Surgery, Medicine, Cardiac, and Pediatric. The outcomes of this collaborative care include a 65 percent reduction in sepsis mortality rate, a 75 percent reduction in time required to approve system-wide care guidelines, and a significant contribution to a system-wide cost savings trajectory of more than $100 million over the last three years.

Lowering Sepsis Mortality and Length of Stay: One Hospital System’s Story

Sepsis, a serious complication that strikes quickly and is often fatal, is the single most expensive condition to treat in the hospital, in part because of the longer than average stay. To reduce sepsis mortality rates, which are between 20 and 50 percent, many hospitals have established evidence based bundles comprised of antibiotic administration, lactate level monitoring and other elements of care. However, without analytics, hospitals rely on manual processes to track sepsis rates and bundle compliance. Learn how Mission Health has streamlined surveillance by 75% while experiencing a 2.6% reduction in sepsis mortality rates and an 18% reduction in length of hospital stay.

How to Reduce Sepsis Mortality Rates by 22 Percent

Northwest healthcare organization Multicare reduced septecemia by 22 percent, leading to a $1.3 million cost savings in the same period. Now the organization is tackling other areas of improvement. Discover what triggered the improvements — and how these resulted in savings.