2.50
Hdl Handle:
http://hdl.handle.net/10755/203165
Type:
Presentation
Title:
Reducing Hospital Mortality by Improving Sepsis Care Problem
Abstract:
(Summer Institute) Problem: Sepsis is the leading cause of hospital mortality in the United States today. Kaiser Permanente Northern California (KPNC) developed new approaches to identification, stratification and treatment to reduce mortality in this population. Evidence: Early Goal Directed Therapy (EGDT) was first reported in 2001 as effective in reducing mortality but few hospitals have successfully implemented effective programs. In fact, in the International Surviving Sepsis Collaborative, specific hemodynamic targets were achieved only 24-38% of the time after two years. Strategy: The KPNC Surviving Sepsis Program was born out of our 950 chart, 19 hospital mortality reviews in the spring of 2008. These reviews, in combination with our Hospital Standardized Mortality Ratio (HSMR) status, identified significant sepsis care improvement opportunities. Practice Change: KPNC implemented a comprehensive program at all 21 hospitals that would (1) quickly and consistently identify patients who present with sepsis in our emergency department, (2) stratify risk in each by lactate testing, (3) reliably execute effective EGDT where indicated, (4) aggressively treat and monitor those at intermediate risk. Evaluation: The KPNC Surviving Sepsis Program is unique in (1) its successful adoption of a single standard of sepsis care across an entire hospital system, (2) the rate of care improvement, (3) the high EGDT process measure performance and (4) EGDT mortality outcomes below published reports. Results: Our outcomes included (1) 40% reduction in raw sepsis mortality (25% to15%) (2) 25% reduction in risk-adjusted sepsis mortality (3) 14% reduction in overall hospital mortality and HSMR and (4) a reduction in sepsis related hospital length of stay. Recommendations: We recommend using the Model for Performance Improvement framework created by the Institute for Healthcare Improvement (IHI). The project also requires adequate resources to allow for abstraction, reporting of data and ongoing evolution of the project. Lessons Learned: A training module was developed to teach physicians how to properly code sepsis cases; Ongoing training of professional staff needs to be built into the program; Senior leadership support is critical to success. Bibliography: Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich B…. Early Goal-Directed Therapy Collaborative Group. (2001). Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 345(19):1368-1377. Nguyen, H.B., Rivers, E.P., Knoblich, B.P. Jacobsen, G., Muzzin, A., Ressler, J.A. & Tomlanovich, M.C. (2004). Early lactate clearance is associated with improved outcome in severe sepsis and severe shock. Critical Care Medicine. 32(8):1637-1642. Shapiro, N.I., Howell, M.D., Talmor, D.,Nathanson, L.A., Lisbon ,A., Wolfe, R,E. & Weiss, J.W. (2005). Serum lactate as a predictor of mortality in emergency department patients with infection. Annals of Emergency Medicine. 45(5):524-8. Dellinger, R.P., Levy, M.M., Carlet, J.M., Bion, J., Parker, M.M. Jaeschke R….Vincent, J.L. (2008). Surviving sepsis campaign: international guidelines for management of severe sepsis and severe shock. Intensive Care Medicine. 34(1):17-60. Jones, A.E., Shapiro, N.I., Trzeciak, S., Arnold, R.C., Claremont, H.A., Kline, J.A. & Emergency Medicine Shock Research Network (EMShockNet) Investigators. (2010). Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 303(8):739-46. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Mortality; Sepsis
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleReducing Hospital Mortality by Improving Sepsis Care Problemen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203165-
dc.description.abstract(Summer Institute) Problem: Sepsis is the leading cause of hospital mortality in the United States today. Kaiser Permanente Northern California (KPNC) developed new approaches to identification, stratification and treatment to reduce mortality in this population. Evidence: Early Goal Directed Therapy (EGDT) was first reported in 2001 as effective in reducing mortality but few hospitals have successfully implemented effective programs. In fact, in the International Surviving Sepsis Collaborative, specific hemodynamic targets were achieved only 24-38% of the time after two years. Strategy: The KPNC Surviving Sepsis Program was born out of our 950 chart, 19 hospital mortality reviews in the spring of 2008. These reviews, in combination with our Hospital Standardized Mortality Ratio (HSMR) status, identified significant sepsis care improvement opportunities. Practice Change: KPNC implemented a comprehensive program at all 21 hospitals that would (1) quickly and consistently identify patients who present with sepsis in our emergency department, (2) stratify risk in each by lactate testing, (3) reliably execute effective EGDT where indicated, (4) aggressively treat and monitor those at intermediate risk. Evaluation: The KPNC Surviving Sepsis Program is unique in (1) its successful adoption of a single standard of sepsis care across an entire hospital system, (2) the rate of care improvement, (3) the high EGDT process measure performance and (4) EGDT mortality outcomes below published reports. Results: Our outcomes included (1) 40% reduction in raw sepsis mortality (25% to15%) (2) 25% reduction in risk-adjusted sepsis mortality (3) 14% reduction in overall hospital mortality and HSMR and (4) a reduction in sepsis related hospital length of stay. Recommendations: We recommend using the Model for Performance Improvement framework created by the Institute for Healthcare Improvement (IHI). The project also requires adequate resources to allow for abstraction, reporting of data and ongoing evolution of the project. Lessons Learned: A training module was developed to teach physicians how to properly code sepsis cases; Ongoing training of professional staff needs to be built into the program; Senior leadership support is critical to success. Bibliography: Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich B…. Early Goal-Directed Therapy Collaborative Group. (2001). Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine. 345(19):1368-1377. Nguyen, H.B., Rivers, E.P., Knoblich, B.P. Jacobsen, G., Muzzin, A., Ressler, J.A. & Tomlanovich, M.C. (2004). Early lactate clearance is associated with improved outcome in severe sepsis and severe shock. Critical Care Medicine. 32(8):1637-1642. Shapiro, N.I., Howell, M.D., Talmor, D.,Nathanson, L.A., Lisbon ,A., Wolfe, R,E. & Weiss, J.W. (2005). Serum lactate as a predictor of mortality in emergency department patients with infection. Annals of Emergency Medicine. 45(5):524-8. Dellinger, R.P., Levy, M.M., Carlet, J.M., Bion, J., Parker, M.M. Jaeschke R….Vincent, J.L. (2008). Surviving sepsis campaign: international guidelines for management of severe sepsis and severe shock. Intensive Care Medicine. 34(1):17-60. Jones, A.E., Shapiro, N.I., Trzeciak, S., Arnold, R.C., Claremont, H.A., Kline, J.A. & Emergency Medicine Shock Research Network (EMShockNet) Investigators. (2010). Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 303(8):739-46. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectMortalityen_GB
dc.subjectSepsisen_GB
dc.date.available2012-01-16T11:00:55Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:00:55Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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