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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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?

9. 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
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

10. 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