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How to Attack Sepsis

Pennsylvania hospital offers some tips

Sepsis is the most expensive condition treated in U.S. hospitals, costing more than $20 billion per year to treat, according to an article posted on the HealthLeaders Media (HLM) website. Many hospitals and health systems have responded with coordinated treatment approaches.

At Reading Health System in West Reading, Pennsylvania, senior leaders recently created clinical-effectiveness teams designed to find strategies for improving the care of patients with sepsis along with renal failure, chronic obstructive pulmonary disease, heart failure and shock, and gastrointestinal hemorrhaging, as well as in patients undergoing bowel surgery.

Each of the six teams consists of a physician lead, a nursing lead, a quality expert who functions as the facilitator, and five to seven subject-matter experts, such as an infectious disease specialist, a cardiologist, or a bedside nurse, the article notes.

Gregory Sorensen, MD, Reading Health’s senior vice president and chief medical officer, told HLM that the skyrocketing rates of sepsis motivated the health system to make it a key area of emphasis.

Hospitals in the state are required to report all inpatient information to the Pennsylvania Health Care Cost Containment Council, an independent state agency formed to address rapidly growing health care costs. The aggregated data have shown a sharp increase in sepsis in recent years.

“What we discovered over the past five years through these data is there has been a 74% increase in sepsis in patients. One reason is because we are better able to diagnose it. The other factor may be that there are, in fact, higher numbers of patients with comorbid diseases for sepsis,” Sorensen said.

“With those two things in mind, we think the higher number of patients with sepsis is an important piece to focus on. Our goal for the sepsis team is to achieve reductions in mortality, morbidity, length of stay, and cost of care.”

Reading Health recommends four basic steps when attacking sepsis: test clinical hypotheses; make few process changes; highlight patient quality over hospital costs; and switch to risk-based payment contracts.

Test Clinical Hypotheses

For about the last 8 months, Reading Health has been focused on identifying ways to drive the early identification and treatment of sepsis, HLM says. One of the sepsis team’s core strategies is to establish hypotheses, institute clinical changes to test them, and monitor their effect on patient care.

One hypothesis was that the earliest possible diagnosis of sepsis risk for patients coming into the emergency department would lower severity.

“We modified early-warning systems that look at the risk factors and identify patients who may be high sepsis risk candidates. Then, we order additional diagnostic tests and intervene earlier with fluids, blood cultures, and antibiotics. We measure from the time they enter the ED to the initial diagnosis to interventions with fluid therapy and antibiotics,” Sorenson said.

“We’ve seen some very important reductions in our morbidity, mortality, and length of stay numbers as a result,” he added.

So far, Reading Health has experienced a 17% reduction in length of stay, a 40% reduction in mortality, and a 13% reduction in costs for its sepsis patients, Sorensen reported.

Make Few Process Changes

Robert Jones, DO, Reading Health’s medical director for performance improvement and clinical integration, said that to achieve success when redesigning processes, it’s important to make incremental changes so that clinicians are not overwhelmed and are more likely to support the new methods.

“When making process changes, you don’t create tasks that are incredibly difficult to do and require a lot more work. You look for small changes that have a large impact,” he told HLM.

“We are identifying things that look to have statistical significance, and the team will work to identify what is the best way to execute those so they make the most sense. Then our leaders are going out on the floor and making sure everyone is engaged in the process. They are also looking at how successful it is or isn’t and seeing how to improve upon it.”

Highlight Patient Quality Over Hospital Costs

Another critical component of attaining long-term success for these kinds of efforts is to emphasize the effect on patients rather than the financial benefits to the organization, Sorensen said.

“One of our early missteps was to talk about this in terms of cost of care. Physicians don’t care about what the cost is as long as the outcomes are right, and that is the correct approach. But we know that it almost always costs less to do it right.”

Switch to Risk-Based Payment Contracts

While insurance companies currently profit the most from quality enhancements, such as the sepsis initiative, Sorensen said that will change over time as Reading Health engages in more risk-based payment contracts built around population health models.

“Many of these benefits go back to the insurance company because we don’t have the right structures in place yet to share in some of that benefit … [but] it is how we are going to get paid in the future,” he said.

Source: HealthLeaders Media; May 18, 2015.



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