STRATEGIES FOR SUSTAINING REDUCTION IN SEPSIS MORTALITY

Transcription

1 STRATEGIES FOR SUSTAINING REDUCTION IN SEPSIS MORTALITY 10 th OHA Annual Quality Summit June 14, 2017

2 MERCY MEDICAL Mercy Medical Center is a ministry of the Sisters of Charity Health System. As a Catholic hospital, Mercy Medical Center upholds the mission and philosophy of the Sisters of Charity of St. Augustine and continues to be responsive to the needs of the community. 620 members on its Medical Staff Employs 2,500 people Mercy operates outpatient health centers in Alliance, Carroll County, Jackson Township, Lake Township, Louisville, Massillon, North Canton, Northeast Canton, Plain Township and Tuscarawas County. Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

3 MERCY MEDICAL CENTER, CONT D Operates a 476-bed hospital serving Stark, Carroll, Wayne, Holmes and Tuscarawas Counties and parts of Southeastern Ohio 2016 Emergency Room visits = 70, Inpatient admissions = 16,352 Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

4 OVERVIEW OF STRATEGIES Mercy began a mock sepsis abstraction in January 2015 to identify strengths and weaknesses within the system. Physician Champion identified: Dr. Frank Kaeberlein (ED Medical Director) began identifying practices to best implement the Sepsis Campaign guidelines. Sepsis Interdisciplinary Committee established in September Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

5 INTERDISCIPLINARY TEAM Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

6 IMPLEMENTATION Defined specific medical provider responsibility for 3 Hour versus 6 Hour Bundle elements September 2016 Education distributed to every staff physician - September 2016 Sepsis Order Set and Sepsis Alert initiated in Emergency Department - October 2016 Electronic Sepsis Order Set implemented house wide November 2016 Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

7 IMPLEMENTATION, CONT D Automated the Lactate process November 2016 ED Lactates obtained POC by Respiratory Dept. with results > 2 provided directly to ED physician by RT If > 2 then repeat 5 hour Lactate Order placed for Laboratory by Respiratory Dept. Sepsis screening added to in-house nursing shift assessments November 2016 Sepsis screening added to Rapid Response order sets November 2016 ED Sepsis Alert process updated to utilize modified SIRS criteria at triage and reduce excessive test ordering February 2017 Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

8 ED SEPSIS SCREEN / ALERT Does the patient have any two of the following? Temp >100.9 or <96.8 Heart rate > 90 Respiratory rate > 20 Pulse ox < 90% SBP 90 or MAP 65 New altered mental status If yes, then: Initiate all orders in Nursing Orders Sepsis Make patient ESI 2 Make ED provider aware of Sepsis Alert Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

9 ED NURSING ORDERS-SEPSIS CBC with diff BMP PT(INR)/PTT POC Lactate with 5 hour repeat if > 2.0 IV lock Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

10 RAPID RESPONSE SCREEN Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

11 SEP-1 MERCY MEDICAL Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

12 MORTALITY RATES Severe Sepsis & Septic Shock Report, April 2017 Northeast Ohio Regional Quality Collaborative, 2013 Q Q4 Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

13 ONGOING PI Mandatory Health Stream Education of all current and future nursing staff Hospitalists have education and review of Sepsis Protocol during weekly staff meetings Monthly Data review with OFI s identified at individual caregiver level if possible Quarterly Sepsis Committee Review of Data to identify any areas of concern Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

14 CHALLENGES Repeat Focus Exam within 6 hours of identification of Septic Shock Hospitalist Education ongoing for Sepsis Protocol Increased volume of ED holds 2017-Q1 which have hindered 3 Hour Bundle elements like timely doses of antibiotics Sepsis literature has moved from SIRS-based to SOFA-based criteria, resulting in disconnect between EBM and CMS clinical measure Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

15 SUMMARY Emergency Dept. utilizes Sepsis Alert Board to improve Physician response time for identification and treatment of Sepsis. Improved response from 75% Qtr to 94% Qtr Hospitalists have education and review of Sepsis Protocol during weekly staff meetings with 97% Sound physicians using correct SEP-1 orders. Continued rate > 65% meeting all portions of the SEP-1 Measure Quarter 4, Decreased Sepsis Mortality under the statewide rate since Quarter Sustaining Sepsis Mortality Reduction OHA Quality Summit June 14,

16 OHA collaborates with member hospitals and health systems to ensure a healthy Ohio Frank J. Kaeberlein, MD, FACEP Medical Director, Department of Emergency Medicine Frank.Kaeberlein@cantonmercy.org Ohio Hospital Association 155 E. Broad St., Suite 301 Columbus, OH T ohiohospitals.org