As caring healthcare professionals, we’ve been trying to decrease sepsis rates for a long time. We’ve read many articles, adopted many new treatment guidelines and submitted many quality measures, yet sepsis remains the number one cause of mortality for patients in hospitals.
To contain it, we must define it. Yet everyone is challenged by the Sepsis CMS Core Measure program, or SEP-1, with its “all or nothing” requirements. We commiserate over the burden of identifying, documenting and reporting, hoping our clinical teams are doing all the right things real-time. We spend countless hours and valuable clinical time to keep patients free from the perils of sepsis, but once it gets its foot-hold, the clock is ticking. We must identify and treat as quickly as possible (3-6 hours after identified). We wonder if there are alternatives to this process.
What if early warning signs allowed an 8- to 16-hour window, to contain the infection prior to progression or even reaching a full sepsis state? We could eliminate the need to report, outcomes would improve significantly, and our workload would lighten.
Today, most sepsis clinical management workflows are traditional, have been decentralized, and are the responsibility of each unit throughout the hospital… resulting in many issues and greater frustration:
- Education: Hospitals train large number of clinicians, at least yearly, for relatively infrequent events that occur on their units.
- Interpretation: To define sepsis takes time and research. Sepsis data is located in multiple locations, requiring multiples clicks, and results are not always presented at the same time or on the same page within the electronic health record (EHR).
- Notifications: Timely access to relevant information and hence speed of response is compromised when clinicians must log into the EHR to seek out and interpret data and frequently just to see sepsis alerts themselves. Furthermore, there is a high rate of false positive sepsis alerts, contributing to overall alert fatigue in the hospital environment.
- Documentation: Documentation is fragmented, not always timely, and has hundreds of data points to consider. It is challenging for any clinician to see the true clinical picture or progression of deterioration in 5-10 columns of data in the EHR. This significantly slows any quick identification and clinical decision support processes.
- Definitions: Subjectivity, disagreement, and change cloud the definition of “Time Zero” and other data collection points outlined by expert panels and policy governance bodies.
- Data Collection: Data is usually a retrospective, manual, and subjective process with no credit unless all data elements are 100 percent compliant with all CMS requirements. No misses are allowed in the 3- to 6-hour bundles.
There is a way to use advanced clinical surveillance to be less subjective in areas where objectivity can supplement our clinical intuition. The Rothman Index (RI) helps warn care providers of patient deterioration before it becomes critical by drawing on hundreds of data points from the EHR, including all the factors that comprise the full range of head-to-toe nursing assessments, vital signs, laboratory results, and admission/discharge/transfer (ADT) data. Head-to-toe nursing assessments are a unique and proprietary element of the RI calculation and are proven to identify functional deterioration before vital signs or laboratory data.. As an indicator of patient condition and subtle deterioration, the RI has been shown to help clinicians in their efforts to identify patients at risk of sepsis, both when sepsis is present on admission and when it is developed in the hospital.
Imagine having the RI and stepping up even further to a world with centralized patient surveillance and proactive clinical response helps to overcome key care delivery challenges. Dashboard views can drive clinicians’ focus and help a highly-specialized staff to eliminate the burden of house-wide staff training while focusing attention where it is needed most, on trends, alerts, and notifications, across the whole population, empowering even a single RN to have insight to the progress of 1,000 patients.
September is Sepsis Awareness Month. Let’s continue working together to predict and prevent sepsis in new and creative ways.
To learn more about clinical surveillance for sepsis, watch Rethinking Sepsis: The Promise of Global Clinical Surveillance.