Screening patients for early signs of sepsis and use of sepsis bundles—a series of checklists and recommendations for providers to follow—have been implemented systemwide, especially in the EDs, ICUs, and medical-surgical units under multidisciplinary team approaches, Rincon says.
"The reality is that healthcare has evolved. In the past it has honored individual expertise and individual smartness," not working as a team, which she dubbed "colony smartness."
Nurses, too, had been used to working in silos. With the ICU "you need to work well with the emergency department and the medical-surgical units to coordinate care," Rincon says.
Under the program, intensivists and ICU-trained nurses use early warning software, advanced video, and remote monitoring to check on critical patients. Physicians monitor the system around the clock.
The system includes video camera feeds from each ICU patient room that sends patients' vital signs to eICU computer systems.
According to a review compiled by Rincon and her colleagues, ICU patients were screened for severe sepsis upon admission to one of 12 ICUs located in 10 hospitals between 2006 and 2008. In those years, nurses identified more than 5,000 patients meeting the criteria for severe sepsis. The evidence-based checklist program resulted in antibiotic administration that increased from 55% to 74% between 2006 and 2008 and central line placement (without infection) that increased from 33% to 50%.
Sharing patient data electronically, eICU nurses are now able to check with specialists who are off-site, she says.
By tracking vital signs, lab results, and orders over a period of days, eICU nurses "may pick up subtle clues and take action to stop a decline" in patients, Rincon says.
Success key No 2: Electronic medical records
As hospital systems are spurred by the government to initiate widespread EMRs in their programs, an important concern is maintaining oversight of records for specific service lines, and that's what Texas Health Resources has done with an EMR automatic risk assessment tool designed to curtail hospital-acquired blood clots.
Three years ago, the THR officials initiated a project to use EMRs to assess each patient's risk of developing a condition, and since then they have continually upgraded the program to refine efficiencies and improve outcomes, says Velasco, the CMIO.
Physicians are alerted when patients are declared at risk for venous thromboembolism and then they can establish medication procedures. Since implementation of the program, the hospital system has seen a reduction in postoperative pulmonary embolism/deep vein thrombosis by more than 20%, Velasco says.
The support program includes a protocol that detects if preventive therapy is not ordered within a timely fashion after a patient's arrival at the hospital; an alert appears in the EMR, reminding the provider to order VTE prophylaxis and suggesting use of a VTE risk assessment calculator, a support tool. With the risk assessment calculator, a clinician uses preventive therapies, such as blood thinning medications and mechanical compression devices, to promote blood flow in patients.
Through its plan, THR achieved stage 1 meaningful use requirements and received federal and state Medicaid incentive payments. Developing a leadership committee to initiate the plan was a key to its work, Velasco says.