Leaders at Greensburg, Pennsylvania-based Excela Health knew they needed to find a new way to reduce sepsis mortality and average length of stay (ALOS) for sepsis patients. After a multi-pronged approach that took several years, the health system saw a drop in both the sepsis mortality rate and ALOS at its facilities.
"Our organization recognized the scope of the impact we would have if we went on this journey to improve care for our septic patients," said Carrie Horner, quality analyst. "Our main goal was to increase awareness of sepsis, provide ongoing education for our clinicians and give them tools to recognize sepsis."
In May 2016, Excela staff worked with Cerner to implement the Sepsis Management solution, including the St. John Sepsis Agent algorithm and workflow integration. The solution looks through the patient's data and alerts providers when a patient begins to display signs of sepsis.
"Excela's mission is to improve the health and well-being of every life we touch," said Mike Widmann, clinical informatics coordinator. "I think by having a system that crawls the chart and looks for warning or danger signs and alerts the care team that those danger signs are there allows us to improve their health and allows us to put the patients first."
"Sepsis Management actually looks at the vital signs as you're documenting them," he said. "If it finds a value that qualifies, it then automatically stores and creates the alerts when the criteria are met. We could customize who saw the alerts so we send them to the appropriate people at the appropriate time."
Utilizing the sepsis solution, along with other efforts, sepsis mortality saw a 20 percent decrease change.1 ALOS saw a five percent change drop.2
In addition to helping patients, the solution also helped staff.
"The Sepsis Management solution removed the burden of doing the manual process we had in place up to that time," said Widmann. "It was a welcome change for the nurses to actually take work away from them."
Localization played an important role in optimizing the solution for providers.
"We take different providers' feedback and make changes if we're able," said Michele Curcio, senior systems analyst. "We also go back to the providers and say, 'We made this change based on your feedback,' to try and keep them engaged and keep us moving forward."
Excela leaders said they expect sepsis mortality and ALOS rates to continue falling as they work together with Cerner to continue improving care.
"I think having the right people on the Cerner side led us to be more successful," said Denise Addis, director of value-based quality. "Having the right clinical skills, understandings and technical skills is key."
"Not only did they help us in the design and training, they were there doing elbow support service when we went live," said Curcio. "They rounded the floors, troubleshot and talked to providers and nursing staff. Once we were done implementing, they still stuck with us and did follow-ups."
1 Baseline from March 2015 - April 2016 of 10.35 percent sepsis mortality rate. Post-implementation data from May 2016 - August 2017 shows 8.25 percent mortality.
2 Baseline from March 2015 - April 2016 of 6.45 average sepsis length of stay. Post-implementation data from May 2016 - August 2017 shows 6.12 average length of stay.