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![The challenge – Health system burden (USA)
Torio CM, Andrews RM: National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160. In: Healthcare
Cost and Utilization Project (HCUP) Statistical Briefs [Internet] Rockville (MD): Agency for Health Care Policy and Research (US) 2006-2013
http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp
#1 in 2011 for USA hospital costs
>$20 billion (5.2% of national costs)](https://image.slidesharecdn.com/aysynwtsiiw6mhhoi4bd-signature-22f737b5f20079229add900b3ee6c3376a41243bfd2dc848a13f30c3a82f06ee-poli-151118004200-lva1-app6891/75/Using-the-EMR-in-early-recognition-and-management-of-sepsis-10-2048.jpg)
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Using the EMR in early recognition and management of sepsis
Dr Nic Woods discusses tools for early recognition and management of sepsis using the electronic medical record (EMR). Sepsis poses a major global health challenge and burden. Tools discussed include a sepsis predictive model built into the EMR that can detect signs of sepsis with sensitivities of 68-91% and specificities of 91-97.6%. Clinical decision support and workflows in the EMR are also used to alert clinicians and guide treatment. Evaluations found these tools helped reduce mortality from sepsis by 4.2-17% and lower length of hospital stays. Key points emphasized that predictive models integrated into clinical workflows can positively impact outcomes, but more progress is still needed.
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Using the EMR in early recognition and management of sepsis
- 2. Dr Nic Woods PhysicianExecutive, Cerner ANZ Using the EMR in early recognition and management of sepsis
- 3. © Cerner Corporation.All rights reserved. This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent . 200+ associates Partnered with 1st client in 1991 3 Offices Sydney Brisbane Melbourne Solutions licensed at over 190 hospitals across the country 100,000+ Unique users Cerner Australia Australia’s 1st fully digital hospital and HIMSS Stage 6 in Hervey Bay
- 4. Topics • The challenge •Some tools • Some outcomes • Key points • Questions
- 5. Topics • The challenge •Some tools • Some outcomes • Key points • Questions
- 6. Sepsis – whatis it?
- 7. Sepsis – whatis it?
- 8. The challenge –Global burden From World Sepsis Day Organisation;. www.world-sepsis-day.org
- 9. The challenge –Severe Sepsis, ANZ ICU’s Kaukonen, KM et al. Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012. JAMA. doi:10.1001/jama.2014.2637
- 10. The challenge –Health system burden (USA) Torio CM, Andrews RM: National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet] Rockville (MD): Agency for Health Care Policy and Research (US) 2006-2013 http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp #1 in 2011 for USA hospital costs >$20 billion (5.2% of national costs)
- 11. The challenge –It affects many of us
- 12. Topics • The challenge •Some tools • Sepsis predictive model • EHR clinical decision support & workflow • Some outcomes • Key points • Questions
- 13. Some tools –Sepsis predictive model
- 14. Some tools –Sepsis predictive model
- 15. Some tools –Sepsis predictive model
- 16. Some tools –Sepsis predictive model
- 17. Some tools –Sepsis predictive model
- 18. Some tools –Sepsis predictive model
- 19. Some tools –Sepsis predictive model
- 20. Some tools –Sepsis predictive model
- 21. Some tools –Sepsis predictive model • Predicted Operating Characteristics for the St. John’s Sepsis Alert (n = 68,962 encounters) Scenario Encounters with Sepsis Encounters without Sepsis True Positives False Negatives False Positives True Negatives Sensitivity Specificity Positive Predictive Value Negative Predictive Value All Cases 2,457 910 15,142 50,453 0.73 0.77 0.14 0.98
- 22. Some tools –Sepsis predictive model
- 23. Some tools –Sepsis predictive model Operating Characteristics • Sensitivity 68-91% • Specificity 91-97.6% • PPV up to 68% Alert fires when system finds 3 signs of systemic inflammatory response syndrome, OR 2 signs of SIRS + one sign of organ dysfunction
- 24. Topics • The challenge •Some tools • Sepsis predictive model • EHR clinical decision support & workflow • Some outcomes • Key points • Questions
- 25. Some tools –EHR CDS and workflow
- 26. Some tools –EHR CDS and workflow
- 27. Some tools –EHR CDS and workflow
- 28. Some tools –EHR CDS and workflow
- 29. Topics • The challenge •Some tools • Sepsis predictive model • EHR clinical decision support & workflow • Some outcomes • Key points • Questions
- 30. Some outcomes -Implementation Monitoring >1 million lives > 490 facilities 31,250 alerts received per hour 748,250 alerts received per day
- 31. Some outcomes –Published evaluations • Multicenter retrospective study, 6,200 patient records • Evaluation by CDS in silent mode with chart evaluation • 195 patients activated alert before sepsis suspected vs 417 patients activated alert after provider recorded suspected sepsis • Median time from arrival to CDS activation was 3.5 hours, and system activation to diagnostic collect was another 8.6 hours Amland, RC, Hahn-Cover, KE. Clinical Decision Support for Early Recognition of Sepsis. American Journal of Medical Quality, November 2014. Available at http://ajm.sagepub.com/content/early/2014/12/10/1062860614557636.full.pdf+html
- 32. Some outcomes –Health service evaluations Since 2010, 1980 lives saved (↓ mortality rate by 4.2%) In FY2014, 156 lives saved (↓ mortality rate by 1.42%) 1 patient every 2 days Mortality ↓ 17%. LOS ↓ from 16.5 to 13.6 days
- 33. Some outcomes –Health service evaluations
- 34. Some outcomes –Health service evaluations
- 35. Topics • The challenge •Some tools • Sepsis predictive model • EHR clinical decision support & workflow • Some outcomes • Key points • Questions
- 36. Key points • Sepsis– it’s nasty & not going away • Predictive models implemented back into the clinical workflow can impact clinical outcome • We do well, but more to be done
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- 40. Topics • The challenge •Some tools • Sepsis predictive model • EHR clinical decision support & workflow • Some outcomes • Key points • Questions
- 41. Health care istoo important to stay the same. TM
Editor's Notes
- #7 Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death. Anyone can develop sepsis, but it's most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival. This is time critical - An important contributor to a positive outcome is early recognition and intervention within a "golden window" before the body progresses to severe sepsis and septic shock
- #8 Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death. Anyone can develop sepsis, but it's most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival. This is time critical - An important contributor to a positive outcome is early recognition and intervention within a "golden window" before the body progresses to severe sepsis and septic shock
- #10 Graph shows mortality of severe sepsis (severe sepsis with and without shock) as a % by year (error bars indicate 95% CI). From 2000 to 2012, we have made great gains with decreased mortality for severe sepsis - 18.4% in 2012 (↓ from 35.0% in 2000)2 But over this time we see this trend of increased cases – more than quadrupled (4.6x) over this time from around 2700 to 12500 – demographic shift to older population (most at risk) etc When you combine this with LOS in ICU around 3.2 days and inpatient of 13.5 days, can see the concern of escalated costs
- #11 Graph shows mortality of severe sepsis (severe sepsis with and without shock) as a % by year (error bars indicate 95% CI). From 2000 to 2012, we have made great gains with decreased mortality for severe sepsis - 18.4% in 2012 (↓ from 35.0% in 2000)2 But over this time we see this trend of increased cases – more than quadrupled (4.6x) over this time from around 2700 to 12500 When you combine this with LOS in ICU around 3.2 days and inpatient of 13.5 days, can see the concern of escalated costs
- #15 Initial content from literature: Surviving Sepsis Campaign1 International Sepsis Forum Consensus Conference on Definitions2 American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference3 Client content validation: Banner, Wellspan, Methodist Health, Trinity Predictive modelling: HealthFacts 1 Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60. 2 Calandra T, Cohen J. International Sepsis Forum Definition of Infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33(7):1538-48. 3 Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644-55.
- #39 Whats next – broader venues of care – residential care would be great, v15 - adding shock index (heart rate divided by systolic blood pressure, normalized by age and sex) and corrected apparent strong ion difference SIDa (undergoing validation)
- #40 Whats next – broader venues of care – residential care would be great, v15 - adding shock index (heart rate divided by systolic blood pressure, normalized by age and sex) and corrected apparent strong ion difference SIDa (undergoing validation)
- #42 (Insert your client’s logo on this slide, to the left of Cerner’s logo) Together, as a team, we have the ability to make a profound difference in the life of a son, a mother, a friend and a neighbor. We owe it to our children, our grandchildren – the generations of tomorrow – to deliver nothing but the best… because health care is too important to stay the same.