The serious health threat of sepsis and the accompanying financial impact is a problem well known in healthcare. It causes half of hospital deaths. Measuring the effectiveness of a hospital’s response to sepsis is much more difficult. Despite significant investment in early detection, health systems lack insight they need to understand, control and ultimately improve the clinical processes guiding treatment of sepsis.
Not achieving hoped-for outcomes often stems from not having the capability for instant insight, improvement and control of vital clinical processes that will produce desired results. Clinical process control is critical to changing the current state.
I’ve seen this during my career as a physician and as Chief Health Information Officer at Hennepin County Medical Center in Minneapolis, and now as Chief Medical Officer at LogicStream Health. For health systems to achieve reliable, high quality, evidence-based care, ongoing improvement, control and automation of clinical processes is must-have capability.
There are a number of forces behind what I call healthcare’s “Quiet Crisis.” The first and most critical issue being lack of clinical process control leading to far too much unnecessary care variation. We have very limited ability to see into the clinical processes in near-real-time to observe this variation and where it can be intervened upon. Therefore, as clinical leaders we can’t find the variation, making it next to impossible to control and actually improve our care delivery.
Clinicians wrestle daily with what some providers call ‘whack-a-mole’ healthcare, including:
- Over-alerting and alert fatigue
- Unnecessary care variation from multiple sepsis order sets
- Limited ability to measure and manage adoption of best practices at multiple levels – by clinician, department and organization
- Correlation of desired outcomes with implemented processes
We recently worked with a Midwest academic medical center to tackle many of these challenges. The medical center charged its sepsis task force with implementing a standardized care process to improve key outcomes. A couple of the key findings are included below. For even more information, download the full case study at this link. Their team struggled for more than two years, not getting the results they wanted but lacking insight into what was hindering their progress, until they finally hit on an approach that provided critical information that enabled them to control and improve their care delivery in sepsis:
- Clinical alerts designed to notify nursing staff to the possible presence of sepsis was not being presented to the right user at the right place in the workflow
- Vast amounts of sepsis-related content in their EHR that had not been updated or retired as new content was added
- Unnecessary variation among groups of providers was causing a lack of uniform ordering and utilization of antibiotics
Part two of this sepsis series will discuss how this system empowered its clinicians to fix, improve and control vital processes guiding care and how this system created a continuous feedback loop for caregivers to improve and better control the care they deliver. It became must-have capability to reduce the impact of sepsis, and to improve patient care and reduce cost.
Brita Hansen, MD, is Chief Medical Officer of LogicStream Health. She began her career as an internal medicine hospitalist physician after receiving her undergraduate degree at NYU and her Doctorate of Medicine from the University of Minnesota School of Medicine. She served as Chief Health Information Officer for the Hennepin County Medical Center before joining LogicStream Health.