January 12, 2017 Dr. Arjun Venkatesh E-Qual Sepsis Kick Off January 12, 2017 Dr. Arjun Venkatesh

E-QUAL: Emergency Quality Network National quality movement, supported by CMS Enrolling over 24,000 Emergency clinicians over the next 3 years to participate in quality improvement activities focused on: Improving outcomes for patients with sepsis Reducing avoidable imaging in low risk patients by implementation of ACEP’s Choosing Wisely recommendations Improving the value of ED evaluation for low risk chest pain by reducing avoidable testing and admissions E-QUAL: Emergency Quality Network What is EQUAL

The current state of sepsis care Leading cause of death in US hospitals Rivers – 47% in hospital mortality 3 Recent Trials (PROCESS, ARISE, PROMISE) – 20% The difference – early recognition and resuscitation Wide variation in sepsis care process and outcomes between hospitals National attention spurred CMS Sepsis-1 metric E-QUAL: Sepsis Care Today

Emergency Care Matters QI efforts Improve outcomes Absolute mortality reduction of ~5% Reduce liability through standardization Improve revenue Implementation of QI projects to improve sepsis care can save lives through: Earlier detection Reduced time to fluids Reduced time to antibiotics E-QUAL: Sepsis Care Tomorrow

Within 3 hours of Severe Sepsis Within 6 hours of Septic Shock New CMS measure: 63 item all-or-nothing bundle Currently, pay for reporting Sep-1 (The CMS Metric) Within 3 hours of Severe Sepsis Within 6 hours of Septic Shock Initial lactate Blood Cultures before Broad-spectrum antibiotics If hypotension or lactate > 4.0: 30 cc/kg fluid bolus Repeat lactate if initial > 2.0 If persistent hypotension after 30 cc/kg fluid bolus: Vasopressors Repeat Volume Status Assessment

Join the Movement! E-QUAL: Sepsis Wave II Over 300 EDs across the US participating National 9-month “group-learning” project Local champion disseminate content and report on ED performance Dedicated data portal and content E-QUAL: Sepsis Wave II

E-QUAL: Sepsis Toolkit DART tool Mobile app with diagnostic/treatment protocols Updates on most recent sepsis literature Information on SEP-1 Webinar/Podcast series Initiation & implementation of Sepsis initiatives Latest developments in Sepsis diagnostics and treatment Quality Improvement guides from leading national experts E-QUAL: Sepsis Toolkit

Best Practices to Improve Care Implementation of a standard diagnostic and treatment algorithms Utilization of EMR for decision support Creation of Sepsis specific order sets to drive best care Leverage best practice alerts to aid in early detection Participate in E-Qual benchmarking to provide feedback to providers What will work in our ED?

MIPS: Merit-based Incentive Payment System New Medicare reimbursement program that links quality and data reporting to reimbursement Emergency Medicine will be scores on 2 categories MIPS: Merit-based Incentive Payment System Medicare reimbursement Automatic reimbursement increases from 2015-2019 After 2019, reimbursement will be based on our performance under MIPS MIPS has two categories for measuring the performance of Emergency clinicians Quality Sepsis care is one of the quality measures Clinical Practice Improvement Activities (CPIA) E-QUAL is likely a high-value CPIA All Clinicians Emergency Clinicians E-QUAL is likely considered a high value activity for CPIA

E-QUAL and MOC Part IV Credit E-QUAL will be listed on the ABEM drop down list of opportunities ED Director will need to be listed attesting that the individual participated in E-QUAL. E-QUAL hopes to develop “automatic” credit soon EQUAL: Extra credit E-QUAL and CME Credit All E-QUAL webinars/podcasts will be associated with eCME credit. To obtain credit visit the E-QUAL homepage