What works? Early recognition It is important that we educate our - PDF document

Surviving Sepsis: University of South Florida Graduate Medical Education and Tampa General Hospital's Quality Improvement Journey September 10, 2018 What works? Early recognition • – It is important that we educate our communities • As many as 87% of sepsis cases originate in the patient’s community – EMS ‐ First responder training and sepsis alert protocols – In ‐ hospital ‐ Frequent assessment using established criteria The Surviving Sepsis Campaign Bundle: 2018 Update • – The 3 ‐ h and 6 ‐ h bundles have been combined into a single “hour ‐ 1 bundle” with the explicit intention of beginning resuscitation and management immediately. • Measure lactate level. – Remeasure if initial level is >2mmol/L • Obtain blood cultures prior to administration of antibiotics • Administer broad ‐ spectrum antibiotics • Begin rapid administration of 30ml/kg crystalloid for hypotension or lactate >4mmol/L • Apply vasopressors if patient in hypotensive during or after fluid resuscitation

Sepsis Post ‐ op Rate 8.00 7.00 6.00 Rate per 1,000 5.00 4.00 3.00 2.00 1.00 0.00 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 6.84 5.42 5.48 6.29 4.80 3.92 5.98 5.17 3.94 3.78 4.94 4.92 4.65 4.28 4.06 4.01 4.84 4.47 5.27 3.56 5.78 HRET HIIN Rate 4.72 3.78 3.98 3.82 3.84 3.58 3.52 3.75 3.43 3.36 3.74 3.36 3.61 3.37 3.53 3.50 3.91 3.88 3.85 3.38 3.58 # FL Reporting 73 67 68 68 70 70 70 69 69 70 69 69 70 69 69 69 67 67 66 65 63 #HRET HIIN Reporting 1,006 1,097 1,094 1,097 1,116 1,115 1,114 1,088 1,089 1,089 1,080 1,083 1,084 1,017 1,014 1,010 1,009 1,001 1,002 881 855 Source: Comprehensive Data System, September 9, 2018

Overall Sepsis Mortality 175.0 150.0 125.0 Rate per 1,000 100.0 75.0 50.0 25.0 0.0 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 154.8 151.2 150.4 141.5 163.7 145.5 150.2 151.9 127.5 139.6 157.1 135.8 150.0 144.7 136.3 149.2 163.4 129.5 135.6 138.9 118.3 HRET HIIN Rate 130.6 115.5 118.5 118.3 129.3 122.8 121.6 120.6 103.8 109.8 113.3 108.1 112.0 113.2 113.0 120.7 130.6 123.8 115.8 118.2 100.3 # FL Reporting 68 72 72 72 72 72 72 72 72 69 69 68 69 68 68 68 66 64 65 64 64 #HRET HIIN Reporting 1,156 1,341 1,344 1,354 1,366 1,364 1,366 1,354 1,348 1,331 1,325 1,322 1,327 1,315 1,289 1,278 1,270 1,260 1,259 1,131 1,107 Source: Comprehensive Data System, September 9, 2018 Hospital ‐ Onset Sepsis Mortality Rate 350 300 250 Rate per 1,000 200 150 100 50 0 BL O ‐ 16 N ‐ 16 D ‐ 16 J ‐ 17 F ‐ 17 M ‐ 17 A ‐ 17 M ‐ 17 J ‐ 17 J ‐ 17 A ‐ 17 S ‐ 17 O ‐ 17 N ‐ 17 D ‐ 17 J ‐ 18 F ‐ 18 M ‐ 18 A ‐ 18 M ‐ 18 FL Rate 238.33 247.00 256.68 267.44 313.77 250.00 287.26 273.22 264.06 313.25 303.03 257.81 299.38 323.67 232.00 306.12 320.65 238.81 254.55 290.80 292.17 HRET HIIN Rate 135.11 205.30 206.44 215.50 255.45 233.00 235.98 234.86 189.33 193.61 173.26 166.27 168.66 200.49 200.90 239.46 204.50 205.11 219.94 231.25 206.43 # FL Reporting 55 56 55 56 56 56 56 56 56 55 55 55 56 55 55 55 53 51 51 50 50 #HRET HIIN Reporting 1,104 1,260 1,262 1,269 1,279 1,276 1,270 1,256 1,250 1,251 1,250 1,245 1,249 1,238 1,222 1,212 1,210 1,199 1,198 1,102 1,074 Source: Comprehensive Data System, September 9, 2018

MTC HIIN Resources Change Packages and Top 10 • Checklists Date of Last Septic Event Poster • Post ‐ op Prevention Process • Improvement Discovery Tool Sepsis Podcast • LISTSERVs • HRET HIIN Website: www.hret ‐ hiin.org MTC HIIN Resources Webinars and Coaching Calls • National Experts • Quality Improvement Fellowships • Patient and Family Engagement • Learning Collaborative Chasing Zero Infections Series • Safety Culture Survey • UP Campaign – SOAP UP, GET UP, • WAKE UP, SCRIPT UP FHA MTC HIIN Website: www.fha.org HRET HIIN Website: www.hret ‐ hiin.org

HRET HIIN Quality Award Winner Congratulations, Florida Hospitals! HRET 2018 High Performance Award Florid ida Hos a Hospit ital al Association Ass Outstanding performance in In Support of the Partnership for Patients Program driving quality care, safety and value across its network of hospitals AHA Lead AH A Leader ershi ship Summ Summit HIIN Recept HII Reception, July July 25, 201 25, 2018 MTC HIIN Upcoming Events • Sep. 12 ‐ QI Fellowship Office Hours #10 • Sep. 13 ‐ Patient & Family Engagement Convening [Orlando, FL] • Sep. 14 ‐ CDI Sprint Summary • Sep. 18 ‐ Reduce Readmissions: Florida Rx Card • Sep. 18 ‐ Sepsis Alliance: Pearls and Pitfalls in the Recognition & Treatment of Pediatric Sepsis • Sep. 20 ‐ Surviving Sepsis: Learn How Florida Hospital New Smyrna Reduced Sepsis Mortality • Sep. 21 ‐ Fall Injury Prevention Strategies • Oct. 16 ‐ TeamSTEPPS Check ‐ in Webinar Check the MTC HIIN Upcoming Events Calendar for details and registration

Contact Us We are here to help! HIIN@fha.org | 407 ‐ 841 ‐ 6230 State Lead: Kim Streit, FACHE, MBA, MHS, VP, Health Care Research & Information Svcs. Improvement Advisors: Cheryl Love, RN, BSN, BS ‐ HCA, MBA, LHRM, CPHRM, Director, Quality & Patient Safety Phyllis Byles, RN, BSN, MHSM, BC ‐ NEA, Clinical Performance Improvement Advisor Dianne Cosgrove, MS, RN, CPHQ, LHRM, Director of Clinical Quality Improvement Communications: Luanne MacNeill, Quality Initiatives Coordinator Data Support: Debbie Hegarty, Manager of Surveys & Special Projects Fellowships & Patient and Family Engagement: Allison Sandera, MHA, Project Manager

9/9/18 Disclosure statement Surviving sepsis: USF GME & TGH’s • I have no relevant financial relationships with manufacturers of any commercial products or providers of quality improvement journey commercial services discussed in this activity. Maya Balakrishnan, MD, CSSBB • I do not intend to discuss an unapproved or investigative Associate Professor, USF Pediatrics use of a commercial product or device in my presentation. Joint Associate Professor, USF COPH Director of Quality and Safety, USF GME Associate Director, FPQC FHA webinar 9/10/18 Engaging interprofessional teams Engaging interprofessional teams in quality improvement in quality improvement can decrease sepsis-related mortality can decrease sepsis-related mortality 1. Discuss opportunities for promoting interprofessional teamwork & QI at TGH & USF 2. Apply the Model for Improvement to address sepsis Empower health professionals Our problem... to advocate for safe , quality patient care . USF Morsani College of Medicine USF College of Nursing USF GME USF TGH USF College of Public Health ... Limited clinical opportunities to apply QI learning Patient outcomes can be improved • Promote meaningful engagement in QI activities by the implementation of QI initiatives • Focus on improving communication • Working in interprofessional teams 1

9/9/18 Our problem... Our problem... USF Morsani College of Medicine USF College of Nursing Meaningful USF College of Public Health engagement ... in QI activities TGH is the Limited major academic affiliate clinical opportunities (education, support, for USF physicians to apply QI learning communication) Patient outcomes can be improved Patient outcomes can be improved by the implementation of QI initiatives by the implementation of QI initiatives Our problem... Our problem... Choosing Efficient & QI initiatives effective use of aligned with existing resources organizational goals (interprofessional teamwork) Patient outcomes can be improved Patient outcomes can be improved by the implementation of QI initiatives by the implementation of QI initiatives Preventing severe sepsis can save lives Think big Meaningful Efficient & Choosing 403 engagement effective use of QI initiatives #1 adults at TGH in QI activities existing aligned with cause of died (2016) 5 inpatient deaths resources organizational Of those nationally 1 >50% ~25% goals develop severe develop septic (education, support, (interprofessional sepsis 7 Hospital mortality ~30-50% 2-4 shock 7 communication) teamwork) Mortality increases by 7% for every hour that sepsis treatment is delayed 3 Patient outcomes can be improved 1 Agency for Healthcare Research and Quality: Healthcare Cost and Utilization Project Statistical Brief No. 160. National inpatient hospital costs: by the implementation of QI initiatives the most expensive conditions by payer, 2011. 8/2013. 2 Alberti C et al, Epidemiology of sepsis and infection in ICU patients from an international multicenter cohort study, 2002. Intensive Care Med, 28: 108-21. 3 Angus DC et al. Severe sepsis and septic shock . N Engl J Med 2013; 369: 2063. 4 Engel C et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study . Intensive Care Med, 2007; 33: 606-18. 5 Vizient Database, TGH report 2016. 6 CDC. Inpatient care of septicemia or sepsis: A challenge for patients and hospitals . 6/22/11. 7 Walkey AJ et al. Hospital case volume and outcomes among patients hospitalized with severe sepsis . Am J Respir Crit Care Med, 2014; 189: 548-55. 2