When leaders at Lafayette General Health in Lafayette, Louisiana realized sepsis was the leading cause of mortality at the hospital, they undertook a large-scale initiative to find ways to improve care and save lives. They decided to use St. John Sepsis agent, create a new position, review documentation and improve the ordering process to help reduce the mortality rate, improve quality measure compliance and impact the bottom line.
“Sepsis is a big component of hospital care. If we can get on the forefront of it, we can get to the point where we can prevent it from deteriorating; that’s always a step in the right direction,” said Mihail Borissov, MD, assistant clinical professor for internal medicine.
Throughout the process, Lafayette worked with Cerner as part of a long-term quality reporting alignment. The relationship allowed Cerner to provide guidance on how to help lower the sepsis mortality rate and improve Centers for Medicare and Medicaid Services (CMS) compliance rates.
From November 2014 to November 2015, Lafayette’s overall sepsis mortality rate stood at 16.54 percent. One way the health center staff decided to tackle that number was to integrate St. John Sepsis agent into the hospital’s electronic health record (EHR).
“It is a crawling algorithm that is looking for patient data on certain types of patients to see if they might be getting sicker,” said Amanda Logue, MD, chief medical information officer. “It’s been very powerful in terms of putting the data together, putting it in front of the clinician and having them look at it.”
After implementing Cerner’s St. John Sepsis agent and taking other actions, Lafayette saw its mortality rate drop to less than 13 percent from March 2016 through February 2017. That equates to an average of more than three lives saved each month from sepsis.
The tool also provides guidance on when physicians need to intervene.
“It gives you an idea of when the patient will potentially deteriorate into sepsis and how you can prevent that,” said Borissov.
Leaders at Lafayette didn’t just rely on technology; they also created a new position. The new sepsis response nurse responds to alerts that fire on patients outside the intensive care unit. That nurse works alongside the patient’s nurse and completes a patient assessment before contacting the physician. If needed, the sepsis response nurse can receive orders from the physician and act to stop sepsis from progressing.
“The sepsis tool allows us to provide real-time alerts to our rapid response team so they can then immediately treat our patients before they get to a state where we can’t treat them for sepsis,” said John Kleyla, director of enterprise systems.
“With the St. John’s Sepsis tool, not only have we been able to intervene earlier and decrease our mortality, but we’ve been able to better document that the patients actually do have sepsis, and it’s being picked up in coding more often,” said Logue.
Lafayette took other steps to improve the mortality rate. After alert implementation, the focus changed to other aspects of sepsis care. This included additional electronic documentation related to sepsis as well as improvements to the sepsis PowerPlan™ order sets to ease physician use during the ordering process. This also helped improve the quality measure compliance by 949 percent.
Catching cases earlier also helped the hospital’s bottom line. Earlier diagnoses impact the prognosis and improve outcomes, as well as increasing efficiencies and costs for both the hospital and the patient. From March 2016 through February 2017, Lafayette saved more than $343,680 in sepsis treatment costs when compared to November 2014 to November 2015.
For information on Model Experience and best practices on configuration and content of Cerner Millennium®, please visit our Wiki page.