Background: Sepsis, a life-threatening organ dysfunction caused by dysregulated host responses to infection (1), remains a major healthcare problem, affecting millions of people worldwide. Out of 48.9 million cases in 2017, 11 million people died, contributing to almost 20% of global deaths (2). Septicemia/sepsis was the most expensive condition treated hospitals in 2016 (3). These findings highlight the need for urgent cost-effective measures to address this issue.The Centers for Medicare & Medicaid Services (CMS) through its Core Quality Measures Collaborative follows specific quality metrics on key clinical areas (including sepsis) to move the U.S. healthcare system from one that pays for volume to one that pays for value of services. CMS identified high-value, high-impact, evidence-based measures that promote better patient outcomes, and provide information for improvement, decision-making and payment. Data is collected by institutions and reported to CMS for public reporting giving patients/consumers opportunities to compare quality across hospitals. Our institution, a large tertiary care academic center, averages around 330 sepsis cases/year, with 1/3 meeting criteria for CMS reporting (ie. Severe Sepsis / Septic Shock). With average daily census of 170 – 200 patients, we expect improving quality of care on this service to have a significant impact on overall hospital core measure sepsis indicators.
Methods: Multi-level intervention to improve our sepsis pass rates. Step 1: • Establish a Division level sepsis committee with physicians and a quality specialist. • Conduct weekly meetings to review failed sepsis cases and provide specific feedback to providers involved. Step 2: • Develop a sepsis order set in the EMR to ensure all necessary labs, nursing orders and antibiotics are used correctly/timely. • Create a sepsis note template to provide guidance on proper assessment and documentation. • Ensure proper sign-out between providers on ongoing sepsis workups. Step-3: • Developed educational material with the most up-to-date sepsis management clinical guidelines. • Provide initial education to current & newly hired physicians via annual best-practice meetings. • Provide feedback for failed cases via email to corresponding providers with attached clinical guidance.
Results: • Program start: July 2017. Pass rate: 32%.• 2X increase in the first year of implementation.• Steady increase yearly over following years.• Sepsis Core Measure Pass Rates by 2021 at 89%.• Statistical significance w p values < 0.005 was seen between groups and within groups.
Conclusions: Hospitals struggle with compliance to sepsis core measures. Our Hospital Medicine direct care service faced similar challenges in 2017 when we decided to implement a multi-level intervention.Detailed chart reviews by a physician and quality specialist were very helpful to identify gaps in care and processes. We addressed gaps with individual physicians while developing systems (order sets and templates) to help ensure compliance. Significant improvements core measure pass rates to near 90% over 4 years were the result of multi-disciplinary care and collaboration. Key lesson: it is integral to have front-line physicians to review cases / identify areas of need. Same front-line physicians communicate with physician colleagues thus increasing buy-in, education and continuously improving processes. Future directions: further improve order sets and spread this process to other services in the hospital.
