MHA Immersion Pilot Project Sepsis November 1, 2016

Project Focus/Problem Statement FHS sepsis bundle compliance is 11.9%. While internal mortality rates for sepsis patients are lower than expected, low bundle compliance highlights some of the gaps in early recognition and treatment of sepsis. Improvement efforts will initially focus on the Emergency Department as well as ground/air emergency agencies.

What initial barriers were identified to project implementation? No policy/protocol Outdated order sets Knowledge deficit around sepsis identification and evidence-based treatment Hybrid nature of EMR Limitations of EMR functionality Competing priorities Global difficulty with change

Hospital Information 460-bed, 3-hospital system located in southwest Missouri Regional referral center 300+ physicians 60+ specialties

Team Members

Percent of Project Quarterly Tasks Completed Task Completion % Exception(s) 1st 89% Bundle kit 2nd 100% 3rd

Key Solutions Implemented Early recognition paper worksheets Electronic triage assessment with risk score Badge buddies FIRST panel in EMR ED physician-authored sepsis bundle-compliant order sheet Use of iStat lactate

Key Solutions Implemented On-demand education for Physicians, Nurses & Nurse Techs including Grand Rounds with CME & CEU Weekly detailed feedback on sepsis performance for leaders ED policy for early recognition & treatment recommendations for sepsis

Key Lessons Learned FHS mortalities were lower than national average Nearly all sepsis patients have pneumonia or an urinary tract infection Teamwork and communication are critical to success Lack of clarity around sepsis bundle elements with recently released definition of Sepsis 3 Immersion project coupled with sepsis core measure roll-out caused confusion

Key Lessons Learned Transition from ED to inpatient units and ED boarding creates an opportunity for missed bundle pieces Sepsis specific SBAR Full sepsis pathway order set underutilized because of length Single page sepsis Core Measure protocol Code Sepsis alert not well received by providers Continued refinement of who should respond

Key Lessons Learned EMR upgrade and abstraction guideline changes in July caused some difficulty with sustainability Interventions are often appropriate and completed but not documented adequately to meet CMS abstraction requirements

Results Overall 14.8%

Sustainability and Spread Plan Inpatient work is now underway Multidisciplinary sepsis oversight committee is continuing to refine efforts based on feedback from bedside staff A sepsis coordinator has been identified; quality department continues to be involved for chart abstraction & regular performance feedback

Tools

FHS’ overall cost index = 0.82 Return on Investment October 2015 – July 2016 discharges MS-DRGs FHS Cost Average Natl Average Benchmark Pneumonia $6,711 $8,842 $7,878 Sepsis w/PN $13,261 $16,457 $14,343 FHS’ overall cost index = 0.82

Return on Investment Lives saved 8 Excess cost per mortality* $16,304 ROI To-Date $130,432 Calculation: $1,500,000,000 / 92,000 deaths = $16,304 / death *http://world-sepsis-day.org/?MET=SHOWCONTAINER&vCONTAINERID=11

Team Accomplishments Staff ability to recognize sepsis earlier in its progression Improved 3 hour bundle completion rate – nearly doubled our success and decreased our mortalities Month long sepsis awareness activity in September Multidisciplinary participation, including business support staff Prizes were awarded!

Next Steps/Future Plans Refine sustainability strategy Continue roll-out in inpatient areas Shift focus to septic shock and 6-hour bundle elements Refinement of EMR order sets for sepsis

Next Steps/Future Plans Outreach education to area nursing homes to increase sepsis awareness Provide ongoing physician and nursing education from most recent published literature Aim for further reduction in mortalities