News: Maryland hospital reduced sepsis mortality by 65%
A sepsis surveillance and treatment initiative at Frederick Memorial Hospital has slashed the facility’s mortality rate for the deadly infection by 65% from 2012 to 2016, according to HealthLeaders Media.
During coding and chart audits in 2012, the organization found that their mortality level for sepsis was one-and-a-half times what the expected levels were (often referred to as the observed to expected ratio, or O-to-E). Upon further digging, they found that the hospital didn’t have effective bundles or processes that were in place to even begin to identify patients at risk of sepsis, says Debra O’Connell, RN, manager of performance improvement at Frederick Memorial Hospital.
The facility’s first step toward addressing its sepsis challenge was developing an EHR-based screening tool which asks about vital signs, potential sources of infection, mental status changes, white blood cell levels. Then the tool calculates a score, and if patients have a score above a value of two, it prompts the nurse to get additional orders from the physician.
After a clinical trial, the screening tool was implemented in the ED and on an as-needed basis associated with specific chief complaints. If the tool indicated that a patient could be septic, the ED staff would implement the appropriate interventions. Then the facility made the tool accessible to all clinicians and nurses throughout the hospital.
In 2017, the hospital started using the screening tool for active surveillance of all inpatients. Now, all patients are screened upon admission and then two times per day after admission, says O’Connell. Initially, the nursing staff resisted the daily screenings of all inpatients, but the reduced mortality rate played a decisive role in widespread adoption.
“We don't want to miss opportunities to capture sepsis because it is a severe disease process. You can go downhill very quickly; and once that process starts to progress, if the appropriate actions are not in place patients can progress into septic shock and die," O’Connell says.
There were two essential elements in Frederick Memorial's successful sepsis prevention initiative, according to O’Connell:
- Physician champion leadership: “The biggest thing is finding some physician champions who can help drive the processes, the culture change, and education of the entire staff. We had a physician leader in our organization who helped drive this initiative and who helped educate our providers.”
- Sharing the data: “The other piece is showing the outcomes—being transparent with information. Once we were able to demonstrate that there were benefits from the screening tool, identifying septic patients, and that our treatments were decreasing mortality rates, that made a big difference with our staff.