1. HVHC Disseminating and Implementing the Sepsis Bundle
October 27, 2015

2. CONFIDENTIAL - Internal Use Only
What is sepsis?
CONFIDENTIAL - Internal Use Only

3. Why improving sepsis care is important
Hospitalizations per 100,000 discharges in the US (NEJM May 2014)
CONFIDENTIAL - Internal Use Only

4. Why improving sepsis care is important
CONFIDENTIAL - Internal Use Only

5. New CMS Value Based Purchasing
Value Based Purchasing (VBP) is the CMS pay-for-performance program for hospitals. CMS payments to hospitals are adjusted based on performance on a number of quality metrics, e.g. your hospital’s rate of CLABSI and CAUTI.
Beginning October 2015, all hospitals will report their sepsis performance to CMS. Beginning October 2016, payment to your hospital will be adjusted based performance on a new sepsis quality measure, SEP.
CONFIDENTIAL - Internal Use Only

6. CONFIDENTIAL - Internal Use Only
New CMS Sepsis Measure
SEP -1 Early Management Bundle, Severe Sepsis/Septic Shock
Denominator: Patients with an ICD-10 code for Sepsis who also meet the clinic criteria for Severe Sepsis or Septic Shock
Numerator: Patients in the denominator who receive all of the elements of early management bundle that are indicated based on their diagnosis.
The Bundle:
Within 3 hours
Measure lactate, antibiotics, blood cultures drawn prior to antibiotics
For Septic Shock only – Fluid Resuscitation
Within 6 hours
For Septic Shock only - Repeat lactate if initial lactate is elevated
For Septic Shock and only if hypotension persists after fluid administration – Repeat volume status and tissue perfusion assessment consisting of either
A focused exam to include vitals signs, cardiopulmonary exam, capillary refill evaluation, peripheral pulse evaluation and skin examination OR
Any two of the following – central venous pressure measurement, central venous oxygen measurement, bedside cardiovascular ultrasound, passive leg raise or fluid challenge.
Exclusions: Patients who expire or are placed on comfort measures within 6 hours; patients transferred from another hospital.
Resources
QualityNet Severe Sepsis/Septic Shock fact sheet
QualityNet Severe Sepsis/Septic Shock FAQs
CONFIDENTIAL - Internal Use Only

7. CONFIDENTIAL - Internal Use Only
HVHC Sepsis Care Model
Between , HVHC members collaborated on improving care for patients with sepsis.
The HVHC sepsis bundle was implemented in 13 health care systems, delivered to over 6,000 patients between spring of 2013 and 2015.
CONFIDENTIAL - Internal Use Only

8. HVHC and the 3-hour bundle CONFIDENTIAL - Internal Use Only
HVHC Sepsis Care Model
HVHC and the 3-hour bundle
The HVHC sepsis project adopted the Surviving Sepsis Campaign (SSC) 3-hour bundle after review of the available evidence.
Three recent landmark publications in the NEJM confirmed the importance of the 3-hour bundle and the relative value of subsequent treatment.
The SSC recommended 6-hour bundle elements were dropped from the HVHC data collection after review of the evidence, and are optional data elements in the CMS sepsis measure (CVP and ScVO2)
CONFIDENTIAL - Internal Use Only

9. HVHC Sepsis 3 Hour Bundle
CONFIDENTIAL - Internal Use Only

10. 90-day post discharge mortality after ED sepsis episode (unadjusted)
CONFIDENTIAL – Internal Use Only

11. CONFIDENTIAL - Internal Use Only
HVHC Sepsis Care Model Dissemination and Implementation Project
The following HVHC health systems have agreed to participate in disseminating and implementing the 3 hour bundle
Baylor Scott and White
Beth Israel Deaconess
Dartmouth-Hitchcock
Denver Health
Hawaii Pacific Health
Intermountain Healthcare
North Shore Long Island Jewish
Providence Health
U of Iowa
Virginia Mason Medical Center
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12. Level of Participation
Each participating unit (ED, ICU or general floor) has selected a level of project participation with different data requirements
Dissemination
Quarterly surveys of unit managers (referred to as “pulse checks,” these are short, 6-question surveys)
Simple Study
Quarterly surveys of unit managers
Adherence to 3-hour process measures indicated by flags (“yes” or “no”)
Full Study
Adherence to 3-hour process measures with time stamps
CONFIDENTIAL - Internal Use Only

13. CONFIDENTIAL - Internal Use Only
Level of Readiness
Each participating unit has selected a level of “readiness” based on past experience and current state. Project goals are determined by level of readiness.
CONFIDENTIAL - Internal Use Only

14. CONFIDENTIAL - Internal Use Only
Projected timeline
Receive baseline data reports in order to set improvement targets
(March 2016)
Readiness Steps for all participating units
(Nov & Dec)
Readiness Assessments (8/17 – 9/11)
Project Data specification overview
(October 2015 TBD)
Data collection for sepsis implementation begins for all (January 2016)
Improvement targets set for each unit per readiness tasks (March 25)
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
2016
2015
Sepsis Project Implementation Webinar
(October )
Implementation for participating units
(January – March)
First quarterly submission of monthly data on the Project Data spec
(April )
Quarterly “pulse check” #1
(November 2)
Submission of 2015 baseline Sepsis data using Project Data specification
(February 2016)
HVHC Fall 2015 Conference: Kick off (10/25-10/27)
CONFIDENTIAL - Internal Use Only