Like other hospitals, Michigan Medicine had focused on improving its sepsis care with multiple quality improvement projects. But it was missing some of the foundational pieces to improve sepsis outcomes.
The mortality index was 1.22, and the hospital ranked 15th out of 20 in U.S. News & World Report list of top 20 performing hospitals on sepsis mortality.
“That’s not where we wanted to be,” said Patricia Poza, RN, quality and patient safety program manager for the adult hospitals at Michigan Medicine, part of University of Michigan Health.
The hospital ended up improving sepsis outcomes by adopting core elements developed by the Centers for Disease Control and Prevention (CDC). Specifically, “we optimized the leadership commitment element, making sepsis an organizational priority by acquiring resources to move from a sepsis quality improvement project to a full sepsis program,” said Poza, who joined other health care experts for an AMA webinar on hospital sepsis programs.
It is the first in a webinar series on the CDC’s Hospital Sepsis Program Core Elements, which can help health care facilities implement, monitor and optimize their sepsis programs and outcomes. This free continuing education webinar series was developed in collaboration with the AMA and CDC’s Project Firstline.
“The key to improving sepsis outcomes is early recognition and prompt treatment, requiring everyone's vigilance,” said Erica Kaufman West, MD, the AMA’s director of infectious diseases who moderated the webinar. The CDC estimates that about 1.7 million adults in the U.S. develop sepsis each year. At least 350,000 die from sepsis, said Dr. Kaufman West.
Antibiotic stewardship guides sepsis model
The hospital sepsis core elements are modeled after a similar successful initiative in antibiotic stewardship, said Ray Dantes, MD, medical adviser for CDC’s Division of Healthcare Quality Promotion.
The purpose of the core elements is to guide hospitals on monitoring and optimizing their sepsis programs. “This includes an emphasis on that leadership support, personnel resources, quality improvement tools, and implementation science,” he said.
Hallie Prescott, MD, associate professor in pulmonary and critical care medicine at the University of Michigan, and a staff physician at the Ann Arbor Veterans Affairs Healthcare System, ran through the core elements. They include:
- Hospital leadership commitment: Dedicating the necessary human, financial and IT resources.
- Accountability: Appointing a leader or co-leaders responsible for program goals and outcomes.
- Multiprofessional expertise: Engaging key partners throughout the hospital and health care system.
- Action: Implementing structures and processes to improve the identification and management of—and recovery from—sepsis.
- Tracking: Measuring sepsis epidemiology, management and outcomes to assess the impact of sepsis initiatives and progress toward program goals.
- Reporting: Providing information on sepsis management and outcomes to relevant partners.
- Education: Providing sepsis education to health professionals, patients, and family or caregivers.
The hospital leadership commitment requires engaging the hospital and health system leaders to allow health professionals to have dedicated time to work on the sepsis program, said Dr. Prescott. Michigan Medicine leveraged this particular element to make improvements to its program.
Reorganizing leadership
There were too many sepsis patients in the institution for one coordinator to handle, noted Jessie King, MD, an assistant professor of hospital medicine and the medical director of sepsis initiatives in the quality department at Michigan Medicine.
The answer was to divide that job into three. One coordinator now supervises the adult emergency room. Another coordinator oversees the adult inpatient hospitals across the institution, and a third is in charge of the pediatrics and women's hospital. The hospital also created a sepsis process lead, who works along with the sepsis coordinators and maintains an overall picture of what's going on across the institution around sepsis initiatives.
“Our adult sepsis team and our pediatric sepsis teams work literally side by side. They share an office to collaborate. And we have connections to and have sought out the expertise of various groups across the institution,” said Dr. King. Several committees that include hospital leadership across different departments also meet on a regular basis to discuss data updates and any barriers to sepsis initiatives.
Through these changes, “we've seen significant improvement in our sepsis performance, particularly in the emergency room,” she added.
Learn more about the CDC’s Hospital Sepsis Program Core Elements.
