Reduce Sepsis Mortality Rates with Five Data-Informed Strategies

Reduce Sepsis Mortality
Rates with Five Data-
Informed Strategies
Kathleen Merkley, DNP, APRN, FNP

© 2021 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Reduce Sepsis Mortality Rates with
Five Data-Informed Strategies
The Centers for Disease Control and
Prevention (CDC) report that at least
one in three inpatient deaths is related
to sepsis.
The condition is a leading cause of
hospital deaths and readmissions in the
U.S., with a total 2019 health system
economic impact of $1.5 billion.
Many health systems experience high
sepsis mortality rates and their costly
ramifications, but the good news is
that most sepsis-related deaths are
preventable.

Reduce Sepsis Mortality Rates with
Five Data-Informed Strategies
This sepsis prevention opportunity means
that health systems can cut high costs
associated with sepsis deaths, and most
importantly, improve outcomes for
patients with sepsis.
With a sophisticated data platform that
can aggregate sepsis data and
immediately surface relevant insights,
improvement teams understand their
sepsis populations and which
interventions best support sepsis
detection, treatment, and surveillance.

A Data-Informed Picture of Sepsis Mortality
Rates Steers Improvement Efforts
Health systems already have a great
desire to combat sepsis, and many have
numerous sepsis prevention and
treatment interventions in place but
that’s not enough to overcome a
sometimes difficult-to-detect disease.
Data infrastructure, such as the Health
Catalyst Sepsis Analytics Accelerator,
combined with commitment and
education, is critical for health systems
to prevent and treat sepsis.

Access to granular-level sepsis data is the
best way health systems can understand
the causes of sepsis (which are often
preventable in the in-patient setting) and
how to remedy them before it’s too late.

For example, comprehensive analytic insight
might reveal a delay in clinicians administering
antibiotics for patients with sepsis.
The sepsis data tools’ drill-down capabilities
would unearth a reason—such as a cumber-
some standard procedure of ordering two
blood cultures before administering
antibiotics—that delays medication for
patients in desperate need of treatment.

Based on this insight, clinical improvement
teams might change the blood culture
order process or educate providers to
administer antibiotics after one culture
instead of two, allowing clinicians to give
potentially life-saving antibiotics sooner.
These small changes can lead to drastic
improvements in early sepsis treatment
and reduced sepsis rates.

Five Data-Informed Strategies to
Reduce Sepsis Mortality Rates
By regularly turning to data, organizations
can tackle sepsis prevention and treatment.
Specifically, health systems can apply five
data-informed strategies to reduce sepsis
mortality rates:
1. Create Alerts for Early Detection
2. Improve Three-Hour Bundle Compliance
3. Optimize Emergency Department Processes
4. Leverage the Centers for Disease Control
and Prevention Sepsis Surveillance Toolkit
5. Implement Care Transition Processes to
Prevent Sepsis Readmissions

#1 Create Alerts for Early Detection
Health systems can use their data
infrastructure (e.g., the Health Catalyst Data
Operating System (DOS™)) to aggregate
their population’s sepsis data.
Improvement teams can use this
comprehensive sepsis data to define pre-
sepsis thresholds and then create custom
EHR alerts that notify the provider of early
sepsis warning signs and the recommended
course of action.

#1 Create Alerts for Early Detection
For example, the EHR could alert a provider
about a patient’s potential for infection, low
blood pressure and rapid heart rate, and
prompt the facility’s best practice, such as
administering antibiotics immediately.
Using past sepsis data to surface insights
and recommended next steps at the point of
decision making helps clinicians detect
sepsis earlier in the process when patients
have the best chance of recovery.

#2 Improve Three-Hour Bundle Compliance
Survival for patients with sepsis depends
on the care team’s interventions.
To ensure effective interventions, health
systems should follow sepsis guidelines,
such as the three-hour sepsis bundle,
that prompts immediate action.
The three-hour bundle includes four
specific actions care teams should take
within three hours of suspecting a
patient has sepsis:
Obtain a blood culture
before antibiotics.
1
Measure lactate levels.
2
Administer broad-
spectrum antibiotics.
3
Administer crystalloid fluid for
hypotension or lactate >4 mmol/L.
4

It is important that health systems have
access to accurate sepsis recognition and
treatment data, such as in the Sepsis
Analytics Accelerator dashboard (Figure 1) to
understand performance and identify areas to
improve their three-hour bundle compliance.

Figure 1: The Health Catalyst Sepsis Analytics Accelerator dashboard.

For example, sepsis data might reveal a
delay in measuring a patient’s lactate
levels within the three-hour timeframe.
This insight would signal a need for a
change in lactate collection processes or
an opportunity to educate clinicians about
measuring lactate levels emergently for
optimal patient outcomes.

#3 Optimize Emergency Department Processes
Sometimes delays in care for other
conditions (e.g., AMI, stroke, traumatic
injury) can lead to delays in sepsis care.
Using data to understand the causes of a
delay in the care process can reveal
opportunities to improve triage practices in
the emergency department (ED).

For example, if a health system’s ED averages
a 90-minute wait and a 40-minute wait for
lactate collection, patients who enter the ED
with sepsis wait over two hours for care.
This time frame leaves less than one hour for
care teams to complete the four recommended
actions in the three-hour bundle, which proves
deadly for some patients.

With this insight from the ED data, the
improvement team can investigate ED
triage processes and possibly obtain
blood cultures or lactate testing during
triage instead of after admission.

#4 Leverage the Centers for Disease Control
To diagnose sepsis more accurately,
organizations can leverage the CDC’s
Sepsis Surveillance Toolkit.
The toolkit includes instructions for creating
a patient cohort based on physiological
data (e.g., vital signs) that the CDC
considers true indicators of sepsis

Using physiological data helps care teams
accurately prevent and diagnose sepsis
the first time.
This approach differs from the traditional
administrative coding identification
approach based on a clinician’s notes
(e.g., written orders, progress notes,
physical exam, etc.), which leaves more
room for error.

To effectively use the physiological sepsis
identification method, organizations need
the reliable data infrastructure mentioned
in strategy #1 (DOS) to rapidly collect and
organize data from multiple sources.
With comprehensive physiological patient
data, organizations are now ready to
accurately detect and treat sepsis.

#5 Implement Care Transition Processes to
Although health systems should prioritize
sepsis prevention, they cannot ignore the
reported 40 percent readmission rate among
patients who have recovered from sepsis.
To reduce readmission rates, care teams can
implement smoother post-acute care
transitions with patients, their families, or
long-term care facilities and discuss possible
prevention tactics.

As part of the transition process, care
teams can identify post-discharge follow-up
appointments to ensure the patient is
leaving the hospital with adequate support.
The care team can also provide education
to the patient and family about reoccurring
infection and the best course of action if
the patient relapses.

For patients who are at higher risk for
readmission (e.g., patients with
comorbidities), clinicians can schedule
regular follow-up calls to regularly
monitor the patient’s progress or
involve home health agencies to
detect setbacks as early as possible.

Along with high sepsis mortality rates,
readmissions related to sepsis are also
more costly than readmissions related to
heart disease, including heart failure and
chronic obstructive pulmonary disease.
As organizations continue to face
diminishing profit margins, they cannot
afford to face sepsis without analytic
insight from sepsis data and supporting
data infrastructure.

Using the five strategies above allows
clinicians to decrease sepsis mortality rates
by detecting the condition early, immediately
applying the best intervention based on the
patient’s individual status and reducing
readmissions for patients who have
recovered from sepsis.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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Kathleen Merkley, DNP, APRN joined Health Catalyst in March 2013, as an Engagement
Executive. Prior to coming to HC, she worked for Intermountain Healthcare as the
corporate clinical IT implementation manager. Kathleen is a registered nurse/nurse
practitioner and just received her doctorate in nursing practice from the University of
Utah in May 2013.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Kathleen Merkley, DNP, APRN, FNP

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement
company that helps healthcare organizations of all sizes improve clinical, financial, and operational
outcomes needed to improve population health and accountable care. Our proven enterprise data
warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in
support of more than 65 million patients for organizations ranging from the largest US health system
to forward-thinking physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

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