Sophisticated Solutions to Address Sepsis at WellSpan Health

By Katy Mena-Berkley
Friday, October 18, 2019

Clinicians at WellSpan Health pioneered a three-pronged approach to efficiently and effectively identify and treat sepsis, a fast-acting and potentially fatal immune system overreaction to infection. Sepsis affects approximately 1.7 Americans annually according to the CDC.

WellSpan clinicians are combining a sepsis algorithm embedded in the health system’s EHR, efforts of coordinated alert and care teams, and evidence-based care protocols to diagnose and treat sepsis in patients who present to the health system’s four emergency departments.

Identifying the Issues

“There was a direct correlation between the time we recognized sepsis, the time we started treating a patient for sepsis, and the clinical outcomes,” says Steven Delaveris, DO, Vice President of the Medicine Service Line at WellSpan. “In the usual, fast-paced environment of an emergency department, we found there could be gaps in terms of the clinical awareness of a patient with sepsis.”

Moreover, Dr. Delaveris and his team observed that when providers identified sepsis, there were inconsistencies with the adoption of evidence-based practices to treat each patient. Treating sepsis with the proper antibiotics, IV fluids and laboratory tests within a specific time frame is associated with better outcomes, so discrepancies in treatment presented challenges for physicians and patients alike.

These were all important acknowledgements that led to the development of a more effective approach that has seen tremendous results.

Clinicians at WellSpan Health hospitals can immediately implement interventions after the EHR alerts them to a sepsis order.

A Framework for Timely Treatment

A critical component of the sepsis algorithm EHR system is alert logic that identifies at-risk patients and notifies the WellSpan Central Alert Team, which is comprised of registered nurses with intensive care unit or emergency department experience, as well as sepsis management and protocols.

The Central Alert Team is solely dedicated to watching for sepsis alerts in the EHR across all WellSpan hospitals, validating potential positives and, in the event of a true alert, immediately notifying the bedside team to ensure that interventions are implemented in a timely sequence. Additionally, in instances of false alerts, the Central Alert Team documents the information and continues to closely monitor the patient.

When treatment is required, clinicians can rely on a sepsis order set embedded in the EHR that immediately provides detailed, evidence-based guidelines.

“Clinicians only have to engage that order set to gain access to best practices information, which allows the physician and nurse more time to spend with the patient as opposed to trying to remember or look up information that might be inconsistent with proven guidelines,” Dr. Delaveris says. “We provide real-time decision support for the care team in terms of implementing evidence-based best practices to the bedside team at our hospitals.”

Additionally, the EHR system is able to support the care team in the stratification of sepsis diagnoses and appropriate care according to the alert algorithm, categorizing patient cases as sepsis, septic shock or severe sepsis under the care team’s oversight. This cascade of interventions enables clinicians to deliver timely care with the right antibiotics and treatment personalized to each patient’s condition.

“Anyone who has an infection is at high risk for sepsis, and clinicians need to over-communicate to the patient that they need to adhere to care directions and follow up with a healthcare provider if they do not get better.”
— Steven Delaveris, DO, Vice President of the Medicine Service Line at WellSpan Health

Exhibiting Excellence

The algorithm and alert logic have had a direct impact on clinical outcomes. Specifically, WellSpan’s sepsis mortality rate is now half of what it was two years ago when the methodology was first implemented.

“Each of our four hospitals is now in the top 10% in terms of sepsis mortality performance when compared to like hospitals,” Dr. Delaveris says. “The system has been quite effective.”

Underscoring the success of this approach is WellSpan York Hospital in York, Pennsylvania. A tertiary hospital and Level I trauma center, WellSpan York Hospital is now ranked in the top 2% in the country in terms of performance.

“We had an initial mortality rate of 11% or 12%, and now it is down to 5%,” Dr. Delaveris says.

Recognizing the impact of WellSpan’s work on sepsis identification and management, the system has also been awarded Stage 7 certification from global healthcare advisor HIMSS Analytics, which specializes in the tracking and benchmarking of EHR adoption.

WellSpan’s dramatic results have attracted the attention of several healthcare organizations and health systems. Many have visited WellSpan facilities to learn more about the EHR-embedded algorithm and the Central Alert Team.

“Because of all the interest we attract from organizations across the country, we are working to package a program we can share,” Dr. Delaveris says. “There are a number of things we are doing to help spread the improvement that we have realized here.”

Powerful Partnerships

To maximize the impact it may have on minimizing the occurrence of sepsis and frequency of sepsis-related mortality in the region, WellSpan Health collaborates with area nursing homes and skilled nursing facilities, providing educational presentations, monitoring and support. They also have a strong partnership with the community paramedic program, which serves as a follow-up resource for patients who go home with sepsis.

Additionally, WellSpan encourages increased community immunization programs to prevent the spread of infectious diseases — such as flu, pneumonia, shingles and others — as a preventive measure against sepsis and works with WellSpan VNA Home Care to conduct sepsis screenings every time a nurse visits a patient. WellSpan also relies on home health agencies to guide sepsis patients after they have been discharged from the hospital.

“We work to increase the acceptance, adoption and utilization of home health care services,” says Steven Delaveris, DO, Vice President of the Medicine Service Line at WellSpan Health. “We find that home healthcare nursing helps support medication adherence, as well as assures nutrition, hydration and mobilization of these people. This is especially important in the home environment to help patients heal.”

Palliative care and hospice care services may be included in this continuum of proactive care management, offering education to patients and families when they leave the hospital. If individuals are managing sepsis as well as other chronic conditions, such as advanced lung disease or chronic kidney disease, support from palliative and hospice care in the home is critical.

“We need to get past the misinformation that hospice is only appropriate if a person is dying,” Dr. Delaveris says. “Hospice programs provide a lot of resources to not just the patient who is ill, but also to his or her family.”

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