Physician Engagement at Alabama Hospital is Key to Reducing Sepsis Mortality
In early 2023, the quality department at DeKalb Regional Medical Center (DRMC) – a 134-bed, full-service hospital in Fort Payne, Alabama–selected sepsis mortality as a performance improvement project. Although the sepsis bundle compliance rates were quite good as compared to the sepsis mortality rates, the team was curious about why their sepsis bundle compliance outperformed the benchmark SEP-1 CMS Care Compare National Rate (59.0%), but the sepsis mortality rate did not meet the CMS Focused Population Sepsis Mortality Observed to Expected (1.0). After a coaching call with the Alliant HQIC partner, Alabama Hospital Association, the team initiated an action plan to enhance the identification and diagnosis of sepsis in an effort to meet the observed vs. expected benchmark.
Using a fishbone diagram, the quality department identified the root cause as missing opportunities to identify sepsis after admission. The following actions were taken to improve staff and patient education and awareness:
- Sepsis information mouse pads were placed at computers throughout the facility to provide quick references for nursing staff and physicians.
- Nursing education was provided and reference cards were placed at the nursing stations.
- Sepsis education was added to the in-house patient education channel.
Despite the success of these actions, the team agreed that more monitoring and preventive strategies were needed. However, the physicians were hesitant to establish a Sepsis Committee because the bundle compliance scores were above the benchmark.
This was the around the same time that the quality department staff attended a statewide sepsis event on March 14, 2023. They collaborated with the Alabama Hospital Association to create a committee that would involve more physicians. As a result, a virtual lunch and learn was held on July 20, 2023, where the chief medical officer from a high-performing hospital presented evidence-based practices and experiences related to sepsis. The event saw positive participation from physicians, nurse practitioners, medical students, and emergency department clinicians.
Immediately following the lunch and learn, while still sitting at the boardroom table, a committee was established with a hospitalist serving as the sepsis physician champion, the ED physician medical director as the co-chair of the committee, and the quality abstractor as the sepsis nurse champion. Under their leadership, the quality department establish the following:
- Mission statement: We must recognize sepsis earlier, increase survival rates of sepsis patients through early intervention and treatment, implement international sepsis guidelines, and educate professionals, policymakers, and the public about sepsis to raise awareness of this catastrophic “silent killer.”
- Committee Goals: To improve the rate of recognition and diagnosis of severe sepsis and septic shock from presentation to the ED and latent sepsis that could develop on the inpatient side. The committee aims to improve the sepsis mortality rate and decrease the sepsis mortality score in the process.
Over the next few months, a sepsis policy was reviewed and revised, a severe sepsis screening tool was created, an ED documentation checklist was approved, and a code sepsis process was established after input from the team members. In addition, a Quality Sepsis Memorandum Form was developed to send to clinicians for any sepsis failures, which helped identify trends and opportunities for improvement.
As of October 2023, the severe sepsis screening form, sepsis policy, and other documents, including order sets, were finalized and received final approval from the medical executive committee. The quality team educated inpatient nurses, directors, and house supervisors on the proper use of the sepsis screening form as a tool to determine if sepsis could be present. After the staff education, several mock Code Sepsis drills were conducted and is in the process of go-live.
In this past year, sepsis mortality performance has improved for DRMC and, according to Alliant HQIC data, has exceeded the relative improvement rate (9.0%) over baseline. To date, 17 patient deaths were avoided with a cost savings of $981,274. Other post-implementation data has demonstrated that benchmarks have been met and/or exceeded and the team is confident that these initiatives, including improved physician engagement and a continued focus on sepsis bundle compliance, will be sustained in 2024.
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