Early identification of sepsis and adherence to treatment bundles may reduce mortality by approximately one third, making surveillance a crucial component of sepsis initiatives1. Unfortunately, traditional electronic surveillance to detect sepsis tends not to work. A meta-analysis2 of traditional sepsis alerting studies shows no improvement in mortality, primarily due to poor specificity, resulting in alert fatigue.
With sepsis as a leading cause of death in hospitals, there is a significant price tag to cover the cost of care, totaling 13% of U.S. hospital costs4. The average sepsis treatment cost per case may be as much as $70,000 per patient5 depending on the severity, resulting in millions at risk for a hospital annually.
Wolters Kluwer’s Medical Director of Surveillance, Steve Claypool, M.D. recently presented in a Sepsis Coordinator Network (SCN) Innovation Webinar, and covered how hospitals can:
- Reduce variability in care by improving your clinical team’s adoption of evidence-based guidance
- Empower sepsis coordinators to improve outcomes by minimizing alert fatigue and improving clinical efficiency
- Improve performance in mortality and sepsis core measures and streamline reporting
Reduce variability in care
Every hospital develops order sets for how a patient should be treated, but the effort frequently stops there. To close the gap and improve sepsis outcomes, hospitals must create a process that includes:
- Clearly defined care steps for different stages of the disease process. In addition to the early evaluation of sepsis, processes should detail steps for patients that clinically worsen, including personnel that should be contacted, additional next treatment steps, etc.
- Assigned care roles in the process of treating sepsis for each clinical team member: e.g. nurse, physician, charge nurse, etc.
- Empowering clinical staff to practice at the top of their license to ensure patients receive the right care, such as nurses ordering lactate testing, rapid response teams initiating treatment, etc.
Third-party clinical surveillance solutions integrated with your EHR can reduce variability in care by making it easy for your teams to follow the policies and procedures you already have in place. What’s more, surveillance technology can deliver the alerts and prescriptive orders critical to ensuring evidence-based care into each front-line clinicians’ existing daily workflow—accessed by pager, mobile device, or in the EHR. With your team on the same page, receiving the same information based on evidence-based practices, and trained on how to respond, your hospital will more readily deliver consistent care.
Minimizing alert fatigue to improve response to at-risk patients
Frequently a hospital will turn to its EHR to improve performance using its sepsis-specific modules, alerts, and other functionality. But the results delivered are marginal at best. Simply stated, the EHR is not enough. Studies have shown around 15% specificity for EHRs’ sepsis modules using SIRS-based alerting platform.
Clinicians ignore ~96% of notifications as they’re typically wrong more than 90% of the time; as such, alert fatigue is unsurprising and seemingly inevitable.
Timely, actionable insight empowers your clinical team to work confidently to improve outcomes. Data quality and alerting accuracy are paramount to ensure you identify patients as early as possible; a trusted surveillance tool like POC Advisor identifies sepsis 6 to 8 hours earlier than traditional alerting methods. This surveillance technology’s ability to read clinical notes using natural language processing and analyzing data from the EHR is key to identifying patients with sepsis. The algorithm delivers accuracy in alerting by differentiating abnormalities in lab results and vital signs that are caused by more than a thousand medical conditions from abnormalities due to sepsis, thereby eliminating false-positive alerts that plague other sepsis surveillance systems. POC Advisor is the only surveillance tool shown to reduce mortality, because it is 99% sensitive, 98% specific, and can be pushed to your care team in real-time.
Improve performance in mortality and sepsis core measures
There are a range of issues involved in sepsis management – from complexity of diagnosis to siloed data and documentation issues. Because of this, sepsis often goes underreported and underdiagnosed. There is no single test for the condition; rather, a diagnosis requires experienced clinical judgment based on a complex set of clinical factors.
Speed in diagnosis and treatment is essential
Using technology is one way to improve performance, but these tools must deliver rapid treatment that is compliant with CMS bundles, and carefully monitor how clinicians respond within their workflow to deliver clinical support. Wolters Kluwer’s POC Advisor was created with the express purpose of creating early, accurate, and prescriptive alerting. It delivers 99% sensitivity & 97% specificity, and, in a peer-reviewed study, reduced mortality 53%3.
POC Advisor leverages your EHR data and years of Wolters Kluwer’s expert clinical experience. Our proprietary technology and prescriptive alerts improve the performance of Sepsis Core Measures and support accuracy in reporting. Alerts are pushed to your care team in real-time and tailored to your organization’s needs. The alerts and suggested actions are critical to ensure the timely delivery of labs, fluids, antibiotics, and documentation. What’s more, POC Advisor requires the clinical team member at the point of care to acknowledge or disagree with the suggested alerts, which is critical for tracking compliance with CMS bundles and improving documentation required to ensure accurate reimbursement. Hospitals can identify cases sooner, improving the lives of the patients and potentially blunting the costs associated with hospital-acquired sepsis, mortality, and length of stay.
In summary, implementing a sepsis program that includes protocols, policies, processes, real-time surveillance, and empowerment of staff to do the things that they need to do is imperative. But that’s just part of the equation. By improving the accuracy of alerting, you not only build confidence among your clinical team, but you also enhance patient outcomes to improve your hospital’s overall performance in sepsis care. Additionally, facilities MUST leverage analytics to inform continuous improvement; data analysis should inform your change management and education effort to improve outcomes and regulatory compliance long-term.
1 Damiani E, Donati A, Serafini G, Rinaldi L, Adrario E, Pelaia P, et al. Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS One 2015;10:e0125827.
2 Makam, Anil N., Oanh K. Nguyen, and Andrew D. Auerbach. "Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review." Journal of hospital medicine 10.6 (2015): 396-402.