At the start of fiscal year 2018, leaders at WellSpan Health, an integrated health system serving the communities of central Pennsylvania and northern Maryland, decided to launch a new initiative around sepsis mortality rates. At 11 percent, the system’s sepsis mortality rate was a call to action.
Leaders tapped into Premier’s quality improvement analytics solution - QualityAdvisor™ - and identified that sepsis was the number one admitting diagnosis for each hospital within the health system. In addition, the team discovered that the order set for sepsis was only being implemented an average of 34 percent of the time.
Using this data, the team identified three primary opportunities for improvement:
- Implementing early recognition and best practices.
- Aligning coding and documentation of data.
- Using proactive care management by tapping into a full range of post-acute services.
Prior to the start of this new initiative, the response time to review a sepsis incident was an average of 67 minutes. To streamline the review process, a centralized alert monitoring team was created along with a new alert algorithm for the EHR. A new stratification of order sets was also created to allow for more variation depending on the severity of each sepsis case. The central alert team monitors alerts remotely 24/7 and, like “air traffic control,” works directly with the bedside team to ensure the correct orders are implemented in each sepsis case. As a result of this new process, the screening response time for sepsis incidents decreased to 12 minutes on average. In addition, leaders also saw a dramatic increase in the implementation of order sets, from the initial 34 percent to 91 percent.
Throughout the process, the team continuously tapped into Premier’s QualityAdvisor data to look for opportunities.
“Premier helped us better understand our own data,” said Jodi Cichetti, RN, Senior Director of Quality and Clinical Improvement at WellSpan. “Our definitions evolved over time as we understood their significance. The parameters were so finely tuned that the more we learned about Premier’s data capabilities, the more we valued it as a tool.”
Using Premier data, the team realized that local skilled nursing facilities were one of the primary admitting sources of sepsis patients. As a result, a post-acute team partnered with local skilled nursing facilities to train nurses and care staff to better identify sepsis and its clinical indicators.
“Older people who are in skilled nursing facilities are high for readmission risk, so that gave us the specific area to help support and educate that community,” said Cichetti. “A lot of the prevention and continued treatment is happening outside of the hospital, so that was a really big piece of that care management initiative.”
At the start of WellSpan’s initiative, sepsis mortality rates averaged at 11 percent. By the end of 2018, the health system was seeing an average sepsis mortality rate of 4.5 percent – a 59 percent decrease. When compared against peer facilities, WellSpan York Hospital performed in the top 1 percent.