Change management, technology and CDS: a holistic approach to HAI
By Stephen Claypool, M.D., October 30, 2012
The recent death of 12-year-old Rory Stauton generated a firestorm of media coverage that thrust sepsis and the challenges it presents to the healthcare system into the national spotlight. The missed diagnosis in the emergency department that resulted in a fatal treatment delay served as a devastating reminder of the often tragic – and usually preventable – outcome of sepsis.
Stories such as Rory’s have intensified efforts within the healthcare community to not only find ways to speed diagnosis and treatment of sepsis, but prevent its contraction in the first place. Rory did not contract sepsis in the hospital, however it is one of the primary hospital acquired infections (HAIs) wreaking havoc on the industry today.
Indeed, even before the Centers for Medicare and Medicaid Services (CMS) made HAIs the focal point of several emerging performance-based initiatives, hospitals – 81 percent of them according to Harvard Medical School research – were taking action to address HAIs. Unfortunately, the return on investment has been marginal at best.
The human and financial tolls of sepsis have become blights on the face of the healthcare industry. According to several studies in Critical Care Medicine, sepsis accounts for 215,000 deaths each year in the U.S. and is a significant financial burden, equating to $16.7 billion in unnecessary healthcare expenditures. The number one preventable cause of mortality in hospitals, sepsis rates remain unacceptably high – despite well-intentioned efforts to minimize the fallout.
The problem, according to proprietary research conducted by Market Strategies International, lies with the fragmented and siloed approaches taken with infection prevention, which fail to simultaneously attack multiple pain points identified by physicians and hospital infection preventionists. These issues range from inadequate communication between shifts to the ability to diagnosis and treat the condition in a timely manner, especially in lower acuity areas. Also noted was the need for improved sepsis protocols and quality metrics.
A better approach
A number of the nation’s leading hospitals will soon be beta testing a program that takes a more holistic approach to minimizing the threat of sepsis. A three-pronged strategy will be deployed that includes integration of trusted clinical content driving rule and alerts, Web-based and mobile software to deliver those alerts to the point of care, and change management to impact policy and procedures. These three aspects are integrated to address the challenges the industry currently faces in reducing the rate and severity of this disease and other HAIs.
The program leverages Early Goal Directed Therapy (EGDT) and automated early detection technology and combines it with tools that increase IHI Severe Sepsis Bundle compliance, thereby improving outcomes and reducing the number of patients that progress to septic shock. Importantly, it also incorporates change management techniques, including support for cross-disciplinary workflow to reduce time lags between elements of care.
The first part of the overall strategy is content focused, leveraging a powerful combination of evidence-based reference applications, as well as rules and electronic order set technology delivered at the point of care. Disease-based management programs and data analytics specific to sepsis form the foundation of these tools, and all are automatically updated as new evidence is introduced.
A solid technology platform of advanced surveillance technology forms the second part of the three-pronged strategy and is delivered across a mobile infrastructure driven by real-time, inbound clinical data drawn from EMR and other hospital IT systems. This data is fed through a Web-based infection surveillance system and supported by evidence-based clinical content to deliver roles-based alerts and information at the point of care. Through active surveillance and alerting, patients can be identified at any point of the sepsis continuum – most notably when early risk factors are present and before the progression of the illness.
While technology forms the critical foundation of this holistic approach, it is incomplete without appropriate attention to policy, process and workflow. Simply put, human factors are critical to success.
Change management tactics form the third and final component of the strategy. Affecting real change requires guidance and expert consultation to build appropriate teams, develop an infrastructure and framework for organizational improvement and align key stakeholders across a facility.
Hospitals are currently being sought to participate in pilot testing of this holistic approach. The 12-month test requires each facility to establish specific sepsis protocols and undergo training on early detection of sepsis. Upon completion of the pilot program, sepsis rates will be measured to determine the overall efficacy of the program.
It’s time to get smarter and more thoughtful about eliminating preventable HAIs, such as sepsis. By deploying a three-pronged holistic strategy, clinicians are able to intervene before sepsis turns deadly.
Stephen Claypool, M.D., is vice president of clinical development and informatics for Wolters Kluwer Health. He can be reached at Steve.Claypool@provationmedical.com.
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