This article first appeared January 25, 2018 on HealthLeaders Media.
OhioHealth has lowered the health system’s sepsis mortality rate by 4.3 percentage points over the past two years through staff education and a new diagnostic tool.
“Our estimate is that we have saved about 250 lives,” says James O’Brien MD, director of quality and patient safety at the Columbus-based health system.
Sepsis is the body’s extreme reaction to an infection, which can result in life-threatening symptoms such as multiple organ failure. Annually, more than 1.5 million people get sepsis in the United States, with about 250,000 fatalities.
Starting in July 2015, OhioHealth has reduced sepsis mortality by educating staff members, utilizing a new diagnostic test, reducing the medication response time from hospital-based pharmacists, and creating a clinical culture that tolerates false diagnosis alarms.
The effort required engaging thousands of health system workers about sepsis and highlighting an opportunity for care improvement, O’Brien says.
“A big piece has been making the case that this work is important to us as an organization by looking at the underlying data of what our baseline mortality rate was and how many people it was affecting across our health system,” he says.
When OhioHealth launched the sepsis effort in 2015, the sepsis mortality rate was 24.3%. Last year, mortality in sepsis patients was 20%.
The health system’s wide range of hospital size, from critical access hospitals to its 800-bed tertiary care hospital, has been a significant challenge, O’Brien says.
Emergency care has been a focal point for the initiative, both internally in the health system’s ERs and externally among emergency medical service workers, he says.
“We’ve worked through the Central Ohio Trauma System to get into the mindset of the emergency medical responders because they are significantly as likely to be transporting a patient to one of our hospitals with sepsis as with a heart attack or stroke.”
New diagnostic tool
A new sepsis test developed at Salt Lake City–based BioFire Diagnostics has significantly reduced the laboratory time required to diagnose sepsis and narrow down the best antibiotic treatment, O’Brien says.
“It’s gone from a day or more to a couple of hours.”
The previous generation of sepsis tests requires a lengthy two-step process: A blood culture tests positive for sepsis, then the blood culture is “challenged” with multiple antibiotics to see which antibiotic would be best for treating the patient.
With the new test, once a blood culture tests positive for sepsis, molecular testing quickly narrows down the best antibiotics to treat the patient.
“It helps us to more rapidly identify the bacteria or organism that might be causing sepsis. Once a culture is positive for sepsis, this test helps us to very quickly get to which antibiotic will work best for the bacteria, and, just as important, which antibiotic won’t work,” O’Brien says.
Quicker to the bedside
Once an OhioHealth clinician has prescribed an antibiotic, pharmacists are expected to have the medication at the bedside in less than an hour, he says.
“In pharmacy, you need engagement with the medication safety pharmacist and the antibiotic stewardship pharmacist,” he says “They are the folks who tend to be most in tune with our pattern of resistance to antibiotics and what is appropriate based on where the clinician thinks the patient was infected.”
As has been the case with the health system’s sepsis awareness and education campaigns, there has been no one-size-fits-all approach to boosting pharmacy response times for sepsis patients, and a crucial element of achieving quicker pharmacy reaction times has been including pharmacy representatives on Sepsis Improvement Teams that have been formed at every OhioHealth hospital.
Each team features about a half-dozen members, including the following:
- A healthcare information technologist
- A laboratory staff member
- A pharmacist
- A physician
- A nurse
Forgiving climate for clinicians
Achieving rapid treatment for sepsis patients requires creating a clinical climate that does not penalize caregivers for “false-alarm” diagnoses, O’Brien says.
“We have to be really careful to understand that clinicians are doing a difficult task in trying to figure out what to do, because this is a disease for which there is no single test that says, ‘This is absolutely sepsis,’ says O’Brien. “They are making decisions with uncertainty.”
Given directives from the Centers for Disease Control and Prevention and other organizations to avoid overuse of antibiotics, one of the keys to creating a forgiving climate for clinicians is being supportive of their diagnoses and medication decisions, he says.
“If you go back and beat up the clinicians for having given antibiotics when they were uncertain what the problem was, that’s just unfair to them.”