UAB’S WAR ON SEPSIS
“We recognized that sepsis was a leading cause of death in our
organization and that we needed a different approach to how we
treated it,” says William Stigler, MD, assistant chief medical officer and
sepsis physician champion. “With the implementation of the CODE
Sepsis process and recruitment of a sepsis coordinator, we are now
positioned to greatly improve our response to potentially septic patients
through an evidence-based, standardized process across
care settings.”
“Not unlike other organizations, our leaders knew we needed to
address sepsis-related care if we were to attain the outcomes expected
of us by our patients and the community,” says Anisa Xhaja, manager
of Quality Improvement. “There have been many efforts and pilots over
the years to improve sepsis care (sepsis alert, early warning score, unit
pilots), with varying and limited success. We needed a hospital-wide,
concerted effort and a systematic approach. By declaring a ‘War on
Sepsis’, our UAB Care clinical effectiveness team was able to catalyze
improvement efforts centered on recognizing and treating sepsis,
culminating with a series of meetings with key stakeholders, in which
we defined the ‘UAB way’ to respond and treat suspected and
actual sepsis.” Since implementing the new processes, CODE Sepsis has been
initiated on over 500 patients in the hospital, and over 2,000 sepsis
alerts or orders have been issued for patients in the UAB Hospital
and UAB Hospital-Highlands emergency departments. The Sepsis
PowerPlan, which includes standardized orders for treating new or
worsening sepsis based on the Surviving Sepsis Campaign guidelines,
has been initiated over 2,000 times on almost 1,700 unique patients.
UAB Care, the clinical effectiveness program at UAB Medicine, held
four Sepsis Summits in July 2016 to design and implement a robust
CODE Sepsis process throughout UAB Medicine. These summits
were attended by an interprofessional group of physicians, nurses,
pharmacists, respiratory personnel, and information technology
leaders, as well as frontline staff, to address variation in care in the
management of septic patients. The new CODE Sepsis process
includes an innovative screening tool, early response, and a treatment
process to deliver rapid and standardized care to patients with new
or worsening sepsis, while increasing the sense of urgency. The new
process went live on Oct. 6, 2016, at UAB Hospital’s main campus
and at UAB Hospital-Highlands across all care areas (emergency
departments, acute care, and intensive care). In addition, a sepsis
coordinator position was established in November 2016 to support the
initiative’s momentum and provide continuous, focused education for
nursing and providers.
Sepsis continues to be the leading cause of death in hospitals in the
United States and the most expensive condition billed to Medicare. The
experiences within UAB Medicine have been no different than those of
the country at large. With an observed-to-expected (O:E) sepsis-related
mortality index well above 1.0, reaching as high as 1.77 in July 2015,
and increased expenditures associated with treating the condition, UAB
Hospital leadership declared “War on Sepsis” and set an institutional
goal in FY2017 to reduce sepsis mortality to below 1.0.
The CODE Sepsis process has resulted in improved outcomes for
patients experiencing sepsis during their hospitalization. This is
reflected in UAB Hospital’s sepsis O:E mortality index decreasing to
0.92 in Aug. 2017 – the lowest in the history of UAB and below our
institutional goal of 1.0. This decrease in sepsis-related mortality
equates to 67 lives being saved in 11 months following implementation
of CODE Sepsis. Additionally, downward trends in length of stay (LOS)
and variable cost-per-case have been observed, reflecting sepsis-
related care provided within the hospital that is both clinically effective
and operationally efficient.
“We’ve seen a tremendous response to the CODE Sepsis process
across the hospital,” says Mary Grace Cox, RN, sepsis coordinator.
“Our care teams have risen to the occasion and really embraced these
new processes to most effectively treat patients who become septic
during their hospitalization. Having now reached our goal to achieve a
mortality index below 1.0 for three months, our leaders and staff are
only further motivated to sustain the CODE Sepsis process as the
‘UAB way’ to care for these patients.”
www.uabmedicine.org
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