Wolters Kluwer recently sponsored a roundtable of sepsis coordinators around the country with the Sepsis Alliance.
The discussion turned to the most pressing challenges these coordinators still face. The good news? Solutions are emerging and, in some cases, are already here.
1. Lack of visibility for patients transferring from the ED to floors
Real-time monitoring of at-risk patients is especially important in areas of the hospital where clinicians may not be paying as close attention to early warning signals for sepsis as they do in the intensive care unit (ICU) and emergency department (ED). For example, patients whose ED course is complete but awaiting a ward bed represent about one-third of sepsis cases in the ED. However, far too often, when these patients develop sepsis, thinly stretched resources and the absence of sepsis screening during this transitional period delay their diagnosis and treatment. Crashing within six hours is common.
Bringing together AI-informed sepsis surveillance technology with readily accessible sepsis-specific order sets, detailed policies and procedures tailored to ED transfers, ongoing analysis of performance metrics, and sharing those metrics with all key personnel can yield significant improvements in sepsis-related mortality readmissions and length-of-stay. In addition, tools that have all relevant sepsis data and displays in one place as patients move through their hospital stay increase timely and attentive adherence to each facility's sepsis protocols because there is no need to go back and forth between charts and different tools to look at parameters around vital signs, labs and other key pieces of information.
2. Inconsistent, disparate data compromises reporting
It is critical to have accurate and trustworthy reporting concerning sepsis care since it helps with multiple critical systems, including optimizing reimbursement, maintaining compliance, and providing informative feedback to clinical teams so that they may improve care delivery. Abstractors, on the other hand, are required to do the wasteful and time-consuming work of harvesting data from a range of instruments with varying levels of reliability at an increasingly large number of facilities.
A high-end sepsis surveillance tool consolidates all sepsis-related data in one place and presents it clearly, offering the ability to view every single parameter related to each individual patient.
POC Advisor’s Care Monitor
3. Inability to track time from "almost sepsis" to severe sepsis or septic shock
Sepsis coordinators and frontline nurses may be proficient at recognizing a crashing patient, but they must convince treating physicians to initiate treatment. Having hard evidence in hand can help spur more rapid responses from clinical teams. A tool like POC Advisor, for example, flags four levels of severity, including "rule-out sepsis" for patients who are not yet considered septic but have concerning signs and symptoms, including being on antibiotics with a documented infection, and two SIRS criteria.
Capturing this level of severity prior to an actual sepsis diagnosis gives nurses the evidence they need to convince physicians that if they begin coordinating sepsis care with frontline nurses early, they may be able to generate measurably improved outcomes.
4. Inability to monitor order set usage in real time
Because so few hospitals have the ability to monitor order set usage in real time, physicians in the midst of busy shifts tend to pick and choose individual orders without necessarily following a hospital's carefully designed protocols. Equally important, without visibility into order set usage, clinical teams are more prone to lose track of where patients are in the administration of that order set. POC Advisor's Central Monitor is linked to your organization's order set, enabling real-time views of clinical components of bundle compliance, including all individual items and a timestamp of when items are due and completed. After the fact, intuitive dashboards highlight CMS quality performance metrics for your organization, so sepsis coordinators can drill down to view in-depth hospital performance, including care gaps and trends over time that help identify areas for performance improvement.
5. Poor visibility into time zero
When organizations struggle to identify time zero for sepsis onset, they struggle to comply with CMS bundles. The advantage of a surveillance tool like POC Advisor is that it can closely approximate the time a patient meets the criteria for sepsis by documenting when POC Advisor fires its first alert. That timestamp gives clinical teams the information they need to deliver timely care and abstractors the ability to accurately report compliance for every patient visit.
Tackle sepsis challenges through change management and advanced health technology
While these five challenges appear to be the most prominent and/or concerning for sepsis coordinators, they are hardly the only remaining challenges. For example, a number of coordinators spoke of their desire for a tool that automatically documents and codes, rather than having to abstract and code manually. Developers are moving to make these types of features and others a reality. As they do, it's important to remember that many of the remaining challenges are already solvable, through a combination of change management and advanced technology. Perhaps the most important challenge is convincing hospital administrators to stay focused on this devastating problem and act decisively to solve it.