The Ohio Hospital Association is about halfway through a 124-hospital, statewide initiative to reduce sepsis mortality by 30% by the end of 2018. Data shows the initiative is working and the target is attainable.
About 1,486 lives have been saved since the Ohio Hospital Association began its statewide initiative to reduce sepsis deaths in 2015. A new status report details the progress that’s been made in combating the single most expensive condition in the nation’s healthcare economy. Mike Abrams, president of the Ohio Hospital Association, spoke again with HealthLeaders Media about the progress being made. The following is a lightly edited transcript.
HLM: You’re about 18 months into a three-year initiative. How’s it going?
Abrams: Our goal is by the end of 2018 to have a reduction in sepsis mortality of 30%. We’ve achieve about a 13.5% statewide reduction. I sense a real enthusiasm and a real momentum on our side. You see from the report there has been great uptake on the part of our membership.
Anytime you can make people intellectually curious about a situation, that is half the battle. We have stimulated a lot of discussion and interest in prioritizing this problem. One of the elements of that is a deep and abiding commitment on the part of hospital and health system leadership. The C Suites are committed to resolving this issue.
I always remind audiences when I speak around the state that sepsis is the single most expensive condition in the US healthcare economy. Not only is it costly in terms of human life, it’s very costly for the overall economy of our country. This is something that health systems across the country need to make sure they are prioritizing.
HLM: Are the tools to reduce sepsis already in place? Is it just about increasing awareness?
Abrams: It goes a little farther than increasing awareness, although that is a huge part of it. We have to educate the people throughout the chain of healthcare providers, whether they are licensed professionals or people who are providing healthcare in the home or people driving ambulances. It’s about increasing their awareness. This is something they need to be curious about and interested in, and know the signs of sepsis, and what to do once they’re confident that they have a patient who might be septic. Also, during the handoff period between various providers, we have to make sure each level of care is interested in whether sepsis is an issue with a certain patient.
HLM: Can you explain some of the numbers around your reductions targets?
Abrams: The target rate is 14.9% but the goal is to reduce it by 30%. We did the math the other way around. We felt like a 30% reduction was a stretch goal, frankly. It was not going to be easy. But if we reduce it by 30% that mathematically puts our new rate at 14.9%.
HLM: Are you finding that it’s more difficult to nudge the percentages down now that you’ve plucked the low-hanging fruit?
Abrams: In some ways yes because we have done a really good job of informing our providers about the three-hour bundle and educating our people that this is a race against the clock. When we look at what is next, we are in that second tier of activity. We need to bring it to that next level.
There is the technology that we are talking about that includes working with our electronic health records, and a technology called Capnography, which measures CO2 in respiration. We are piloting with CMS (Centers for Medicare & Medicaid Services) because, when they start using this a little more aggressively, it is going to be a big indicator that they may have a patient who is septic and who needs treatment.
HLM: How are you using EHRs to fight sepsis?
Abrams: At hospitals they refer to alarm fatigue, and there is a little bit of that going on with alert systems in EHRs. You have constant alerts and pop-ups and you can’t always judge which are greater and which are unlikely. We are trying to improve the alert systems in the EHRs. We are also looking at how we use big data and biomarkers. Can we use big data, for example, to show that certain patients with certain characteristics are more likely to be septic than patients with other characteristics? For example, we might learn that certain BMIs or age cohorts or other characteristics might indicate that a patient is at greater risk of sepsis.
HLM: What will you focus on in the remaining months of this initiative?
Abrams: Frankly, one thing is keep doing the things that have been working so far. We want to layer in some new initiatives like this pilot program to see if it works. We want to continue our collaboratives in an all-teach-all-learn environment, where we have people who are curious about programs that are working in hospitals. They are interested in what their sepsis data shows, and they want to learn from each other. The hospitals who are knocking it out of the park can help the ones who might be struggling.
We don’t want to stop what’s working but we do want to layer in new initiatives. I referred to the PDSA Cycle for physicians. “Plan, Do, Study, Act.” Look at initiatives, pilot them and assess if they are bearing the results we need. If they are, work on spreading them.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.