When leaders at Denver-based UCHealth saw last year that 10% of patients with sepsis died from the condition, they acted quickly to root out the problem.
UCHealth gets aggressive to cut sepsis mortality by 15%
The system conducted a study of sepsis patients and found that it was taking too long to get their the antibiotics they needed to stop the infection before it became life-threatening.
The CMS core measure requires that antibiotics be administered within three hours of a patient presenting with signs of sepsis. At UCHealth, patients often waited three hours or longer.
STRATEGIES:Implement an alert in the electronic health record that signals when a patient might be septic.Form a team of caregivers designated to speed the diagnosis and prevention of sepsis.Create a workflow checklist so nurses can quickly administer antibiotics to septic patients as soon as they are available.
If patients received antibiotics within one hour of being diagnosed with sepsis, the mortality rate would decline by 50%, the study found.
"The biggest predictor of mortality in our sepsis patients was timing of antibiotics," said Dr. Jeffrey Glasheen, chief quality officer of UCHealth.
Armed with that information, front-line staff members were asked to come up with ways to ensure patients diagnosed with sepsis received antibiotics in less than 60 minutes. Their ideas culminated in a multistep process that was implemented in January at University of Colorado Hospital, UCHealth's flagship facility.
The efforts have since paid off, resulting in a 15% decline in the sepsis mortality rate, or 39 lives saved, at the hospital so far this year.
The first step in the process is using the system's electronic health record to identify patients who might be septic. The EHR alerts the nurse if a patient has abnormal vital signs and prompts them to check for other symptoms that usually indicate sepsis, such as the patient being disoriented or having deteriorated kidney function.
Although nurses are already monitoring their patients' vital signs for abnormalities, the EHR alert ensures sepsis is top of mind, said Dr. Read Pierce, physician co-chair of the sepsis steering committee at University of Colorado Hospital. About 70% of UCHealth patients with sepsis are septic upon admission.
Based on their other symptoms, the EHR indicates whether or not the patient has a low, medium or high probability of sepsis. For those determined to have a medium or high chance of having the condition, the nurse then is prompted to call in the sepsis team.
The team—a group of caregivers dedicated to giving a quick diagnosis 24/7—was formed at University of Colorado Hospital as part of the effort. It includes a nurse, a pharmacist and a physician or advanced practitioner. If they decide the patient is septic, antibiotics are ordered immediately. The prescription order is marked urgent so the pharmacy has it ready in less than an hour.
A workflow checklist for nurses was also created to ensure they have the support from the sepsis team to administer antibiotics once they are ready for the patient.
Since January, the time it takes for septic patients to receive antibiotics has shortened from more than three hours to roughly 75 minutes. That's still 15 minutes more than UCHealth's original goal, but Pierce is confident that the system will get there soon. The effort has a lot of staff buy-in because they are inspired by the positive results, he said.
Glasheen said a bonus is the effort doesn't require too much involvement from physicians and nurses; pharmacists handle the bulk of the processes. "We didn't have to train 2,000 physicians," he said.
The effort has also contributed to an 11% decline in length of stay in the intensive-care units.
"By recognizing sepsis sooner and getting people antibiotics sooner, they have go to ICU much less frequently and for much less time," Pierce said.
The EHR sepsis alert has now been implemented across all UCHealth hospitals, and been customized for each facility, Glasheen said.
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