1. MHA Immersion Pilot Project Sepsis
November 1, 2016

2. 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.

3. 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Outdated order sets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

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

5. Team Members

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Results
Overall
14.8%

13. 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

14. Tools

15. 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

16. 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 *

17. 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!

18. 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

19. 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