Ken Terry

May 20, 2015

CHICAGO — Implementation of a cloud-based alerting system and change management were associated with a 53% drop in sepsis mortality in a single-site study.

Joycelyn Shipman Craighead, RN, MSPH, director of quality at Huntsville Hospital in Alabama, and colleagues compared the outcomes for patients with sepsis who were treated on two floors of the hospital before the use of the alerting system (January 2011 to September 2013) with the outcomes for patients with sepsis who were treated on the same floors after implementation (March through December 2014). The study floors consisted of three units in which nurses received automated sepsis alerts, including two respiratory units and a general medicine unit. The researchers excluded patients who had previously been in the intensive care unit and those who were receiving limited care because of poor prognoses.

The number of sepsis-related deaths on the screening units decreased from 51 deaths among 566 patients in the control period to nine deaths among 212 patients in the study period, according to an analysis of billing data. In relative terms, the mortality rate fell from 9% to 4.2% (P value = .03; 95% confidence interval, 1.06 - 5.25). Viewed as a function of hospital days, sepsis deaths dropped from 51 per 1000 hospital days to 29, or 43%.

Researchers presented the findings from the observational study here at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition on April 14.

Huntsville Hospital embarked on this experiment after earlier efforts to reduce sepsis mortality had failed, Shipman Craighead explained in an interview with Medscape Medical News. The institution partnered with Wolters-Kluwer because "they could bring in the technology piece that we were lacking," she said.

With the help of Huntsville physicians and nurses, Wolters-Kluwer designed an electronic surveillance system that gathers data from the hospital's electronic health records, including information on comorbidities, medications, vital signs, nursing notes, and laboratory results, and analyzes the information for signs of sepsis. The system sends automated alerts to the nurse on duty when a patient shows signs of sepsis. The alerting system, known as POC Advisor, also provides treatment protocols for individual patients on the basis of their data.

When a nurse receives an alert, the nurse contacts the patient's physician and begins following the sepsis protocol, rather than waiting for the next time the physician rounds on the patient.

From April to June 2014, POC Advisor's alert sensitivity ranged from 94% to 98%, and its alert specificity ranged from 96% to 99%, the researchers said. Shipman Craighead added that the nurses had been closely involved in making sure the system was monitoring the right information.

The hospital had to get the staff involved to make the electronic surveillance system work, she pointed out. "Without the change management piece, it was going to be just another project."

The hospital's change management effort affected nurses, physicians, case managers, and pharmacists, she said. The staff members were educated about how to improve sepsis care. In addition, order sets and protocols were established, and sepsis teams were formed on nursing units.

The nurses were skeptical at first, but the results of the electronic surveillance system "empowered them" and gave them the confidence they needed to alert physicians promptly, Shipman Craighead said. Not all physicians are receiving electronic surveillance alerts directly at this time, but the facility's hospitalists are starting to get them, she added.

Shipman Craighead attributed the drop in 30-day readmissions to the hospital's "all hands on deck," multidisciplinary approach to treating patients with sepsis. In addition, she noted, the patients tend to be in better shape at discharge than other patients with sepsis are.

The authors point out that sepsis deaths did not decline on the other hospital floors not involved in the study, suggesting that the alerting system was part of the reason for the drop in sepsis deaths and that the drop was not because of a general improvement in knowledge and care at the facility as a whole.

Christopher Kodama, MD, MBA, president of MultiCare Connected Care, the accountable care unit of MultiCare Health System in Seattle, Washington, told Medscape Medical News that Huntsville Hospital's success in reducing sepsis mortality was impressive. "My initial reaction is that they have done some incredibly sophisticated work on their alerting/early warning and detection tools — something I intend to share with our team here at [MultiCare Health System]," said Kodama, whose health system has been using data warehousing and analytics to combat sepsis. "Also, I think we share in their observation about change management and adoption as evidenced by compliance with process measures."

Shipman Craighead has disclosed no relevant financial relationships. One coauthor is a salaried employee of Wolters Kluwer Health.

Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition: Presentation 109. Presented April 14, 2015.

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