Hospital-acquired infections (HAI) have taken center stage as a focal point of Medicare's push for more accountability from the healthcare industry. Pay-for-performance strategies across the board point to a movement that is emphatically and systematically aimed at improving performance through a no-tolerance policy for these costly and preventable events.
Representing the number-one cause of preventable mortality in hospitals, sepsis leaves a staggering and unnecessary human toll in its wake. More than 750,000 severe sepsis cases are reported annually in the U.S. and, of those, 215,000 patients die.
The financial toll is also devastating. Total hospital costs associated with the care of severely septic patients is $16.7 billion annually. The excess length of stay per post-operative sepsis case is nearly 11 days, and the cost of treating an ICU patient with sepsis is six times greater than that of treating a patient without sepsis.
Saving lives and reducing unnecessary costs are the driving forces behind several federal initiatives aimed at eliminating sepsis and events that lead to it. For example, the Medicaid 1115 Waiver, a federal pay-for-performance initiative that reimburses hospitals for higher-quality care, is currently being beta-tested in California's public hospitals. The program, versions of which are under consideration by several other states, including Texas, includes focus areas such as the reduction of severe sepsis, central line associated bloodstream infections and surgical site infections.
It's easy to understand why such a high priority is being placed on improving sepsis outcomes. Research reveals that even a modest sepsis mortality reduction at an average 150-bed hospital could save 21 lives and up to $1.75 million annually.
Though it is a high priority, finding an easy answer to this complex issue has not been straightforward. Simply put, the industry's approach to date has been marginal in its ability to impact the condition, and rates of sepsis remain unacceptably high.
The problems are manifold and include delays in initiating treatment, inadequate cross-shift communication, challenges in diagnosing sepsis in lower-acuity areas, lack of sepsis protocols, lack of sepsis-specific quality metrics and limited financial resources.
Sepsis is subtle in its presentation. Early detection requires both human intervention and the ability to track multiple data points scattered across an organization. It requires:
- Interoperability among multiple systems, including electronic medical records, labs, pharmacy and infection surveillance
- Effective clinical-knowledge management processes to build, update and maintain hundreds of rules and protocols
- CDS rules that are standardized yet flexible enough to handle unforeseen scenarios
- Flexible escalation-handling protocols
- A comprehensive mobile component to support the portability needs of today's clinicians, who are no longer tethered to a desktop computer
- Support for clinician-to-clinician communications and push notifications delivered via mobile and other point-of-care devices
Beta testing will soon be underway at hospitals across the country to trial a disease and condition management program that takes a holistic approach to sepsis by integrating trusted clinical content, web-based and mobile software and change-management services. The program is based on the idea that a clinical-knowledge management system that leverages point-of-care decision-support tools linking clinicians to the latest evidence combined with rules-based surveillance technology will facilitate a coordinated cross-disciplinary response that drives early sepsis detection.
When this coordinated clinical-knowledge effort is extended across a mobile platform, clinicians can intervene early and make better-informed care decisions based on actionable, real-time information. Further, enhanced workflow functionality helps facilitate the seamless exchange of information and significantly reduces communication time lags among physicians, nurses and pharmacists across the continuum of care.
Technology will only take the effort so far, though. Solid change-management consulting is also included, as experts working within this field recognize that affecting real change requires building appropriate teams, developing an infrastructure and framework for organizational improvement and aligning key stakeholders.
Disease and condition management is the industry's next step to improving quality, performance and patient outcomes. Given its devastating human toll and financial impact, sepsis is the most logical starting point. Hospitals that combine the best industry tools with an effective strategy for change have the potential to truly impact a silent and preventable killer that has wreaked havoc on people's live for too long.
Sean is vicepPresident of innovation at Wolters Kluwer Health Clinical Solutions and Co-Founder of ProVation Medical.