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Improving Sepsis Care with Data AnalyticsSession 243, February 14, 2019
Mischa Adams, MSN, RN, CCRN, Clinical Standards Coordinator
Sarah Jenson, Analytics Director
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Mischa Adams MSN, RN, CCRN Clinical Standards Coordinator
Consulting Fees: Cheetah Medical
Sarah Jenson, MS
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• History of Sepsis at Allina
• Program Development
• Data Access
• Improvement
• Future
Agenda
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• LO1: Describe how a data-driven approach to sepsis care can improve patient outcomes
• LO2: Describe how a healthcare organization can use data to monitor performance and gain clinician buy-in
• LO3: Explain why an enterprise data warehouse with dedicated septic analytics is essential to increase early identification of sepsis and adherence to treatment bundles
Learning Objectives
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Allina Health is the Minnesota Region’s Broadest Care System
About Allina:
• 85 clinic sites and ambulatory care centers.
• 5,000 physicians.
• 3.0 million+ clinic visits.
• 12 hospitals.
• 103,000+ inpatient hospital admissions.
• $4B in revenue.
• 31% Twin Cities inpatient market share.
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In the U.S., over 1.5 million people are treated for sepsis annually.
One in four people with sepsis die, making improving early
identification and providing patients with timely treatment a top
priority.
Sepsis
Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC: Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med 2012, 186(12):1264-1271.
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• What are your system’s primary challenges for improving sepsis care?
1. Lack of timely recognition
2. Lack of data
3. Wide variation of care practices
4. Other / Unsure
Poll Question
https://live.eventbase.com/polls?event=himss19&polls=4893
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• Clinician awareness of assessment and interventions required for sepsis core measures
• Multiple, often conflicting, procedures to activate a sepsis alert (an early warning notification within the EMR indicating the patient meets criteria for sepsis)
• Fourteen different sepsis order sets
• Understanding documentation processes to accurately reflect patient care
• Lack of data visibility to understand performance
Challenges
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Sepsis at Allina Health
0%
5%
10%
15%
20%
25%
30%
0
50
100
150
200
250
300
350
Mort
alit
y R
ate
Sepsis
Vis
it V
olu
me
Sepsis Mortality over Time
Visits In-Hospital Mortality Rate
AATP
Nurse
Coordinators
Hired Ordersets
Updated
Fluid End
Time
Mandatory
Nursing
Education
Released
Inpatient
Electronic
Screening
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• Develop Sepsis Program
– Leaders from Emergency Medicine, Intensivists, Hospitalists, and Nursing
– Ancillary Pharmacy and Laboratory teams included as necessary
• Sepsis Program Coordinators are registered nurses (RN) with both clinical expertise and performance improvement skills.
– Monitor performance and facilitate process improvement efforts at the point of care
– Ensuring protocols are in alignment with current best practices.
– Develop and Deliver Education
– Deliver Provider feedback
Support
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• Where do most of your patients have the first occurrence of Severe Sepsis or Septic Shock?
1. Emergency Room
2. ICU
3. Med/Surg unit
4. Unsure
Poll Question
https://live.eventbase.com/polls?event=himss19&polls=4895
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• More than 85 percent of Allina Health Sepsis patients had infection with organ dysfunction identified in the ED
– Physician education timely identification and treatment
– Nursing education focused on the early identification of sepsis at triage and rapid initiation of sepsis orders.
Focus
0
200
400
600
800
1,000
Sepsis Volume
ED Identification IP Identification
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• Improving identification of sepsis patients for coding purposes and provider education
• Evaluation of Best Practice Alerts (BPAs)
• Automated identification of organ dysfunction
• Identifies gaps and variation in sepsis care
• Assess Protocol-based interventions
• Provide feedback to physicians about how adherence to bundles improved outcomes
Data Unlocks Improvements
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Please use this blank slide if more space is
required for charts, graphs, etc.
Remember to delete this slide, if not needed.
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• What is your average time from sepsis recognition to antibiotic administration?
1. 0-60 minutes
2. 60-120 minutes
3. 120-180 minutes
4. Unsure / Data is not available
Poll Question
https://live.eventbase.com/polls?event=himss19&polls=4894
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• Early identification has reduced the number of patients developing Septic Shock
Reducing Septic Shock
0
5
10
15
20
25
30
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Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
2014 2015 2016 2017 2018
Rate
per
100 S
epsis
Adm
issio
ns
Sepsis Volume -Rate per 100 Sepsis Admissions
Septic Shock Severe Sepsis
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• Increasing control and decreasing overall average time from identification of sepsis to antibiotic order.
Antibiotic Timing
0
100
200
300
400
500
600
700
Avg Time Zero to Abx Order UCL LCL Mean
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• Demonstrated improvement in Fluid Administration timing
Fluid Administration
0
20
40
60
80
100
120
140
Avg Time Zero to Fluid Complete UCL LCL Mean
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20
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• 18.6% Relative reduction in mortality rate and 10.9% relative
reduction in hospital Length of Stay (LOS) for all patients with
sepsis
• 30.3% relative reduction in morality rate and 18.4% relative
reduction in hospital LOS for patients with sever sepsis and septic
shock
• $1.1 million in annual cost savings, the result of efficiencies and
substantial reductions in hospital LOS for patients with severe
sepsis or septic shock
Results
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• 2019 shift focus to Inpatient presentation of Sepsis
• Ongoing monitoring of ED Shock cases
Future
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• Please complete online session evaluation
Questions
Sarah JensonMischa Adams
