An initiative to harness the surveillance capability of an electronic health record (EHR) in expeditiously recognizing deadly sepsis has resulted in scores of lives saved, hundreds of hospital days avoided and a steep drop in sepsis mortality for Lakeland Health, a three-hospital system in St. Joseph, Mich.
An EHR newly implemented in 2011 enabled informatics leaders there to track the heart rate, breath rate, white blood cell count and temperature of each emergency patient—four potential signs of sepsis— but only if troublesome readings occurred together, said Robert Nolan, D.O., medical director of emergency service. “Our goal was to try to make this a much more transparent diagnosis early on when the patient arrives in the emergency department.”
The grouping of danger signs formerly had to be done by busy emergency physicians getting results back piecemeal while managing multiple patients. But the IT system was set up to track them concurrently, alert nurses and doctors to the potential for sepsis, give them an early chance to diagnose, and then trigger therapies such as use of fluids and antibiotics to head off harm, Nolan said.
Nolan and Karen Kaminski, senior EHR analyst, presented details of the initiative during the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago on April 14. The innovative use of IT to reduce the financial and human cost of sepsis was part of the reason that Lakeland earned a 2014 HIMSS Enterprise Davies Award.
The EHR was deployed to put data in front of physicians and “push them along to a decision” instead of waiting for them to see the danger signs themselves and react, said Nolan. “We were given the opportunity to earlier be able to home in on this diagnosis, which is potentially very expensive and very deadly, and treat them much earlier and prevent some of the [consequences] that can happen if we let these people languish for 6-8 hours . . . and then you’re behind the eight ball,” he said.
Prior to implementing an EHR from Epic Systems Corp., Lakeland had an antiquated information system and many processes of communication were on paper, said Kaminski. The ED had a sepsis improvement initiative but it primarily focused on treating identified cases rather than preventing them. The surveillance capabilities created a systematic approach that sent the sepsis mortality plummeting from 17 percent just before the go-live to 10 percent within two months of using the new system.
The mortality slid further, to about 5 percent, immediately after a second phase of the sepsis reduction program started in mid-2013. Knowing the ED can be hectic and that doctors are not always at the bedside, a process was initiated to present the alert to triage or bedside nurses, who were able to authorize sepsis order bundles to start the medical response without waiting for a doctor to get the information and recognize the danger.
The risk for sepsis was highest among elderly people, and one of the benefits of the automated tracking of symptoms was putting all the pieces together, said Nolan. “Where we really found a lot of mileage on this is that some of our geriatric patients that weren’t communicative, they came in and, unfortunately, what we found is that a lot of this information comes in bits and spurts.” A bedside nurse might get the heart and respiratory rate but not the temp until five minutes into the workup and no blood cell count for a half hour. When physicians deal with eight or nine patients at a time, they might not recognize an issue.
In financial terms, length of stays for sepsis edged down just less than one percent. Length of stay reduction was not a goal of the program, but with about 225 patients per quarter, the savings still could be significant, said Kaminski. In human terms, the success was substantial. Lakeland computed a cumulative 94 lives saved between the 2011 start of the surveillance program and the third quarter of 2014.
