Targeting Instances of Sepsis at Huntsville Hospital
“Evaluating the Impact of a Computerized Surveillance Algorithm and Decision Support System on Sepsis Mortality,” appeared in the June print edition of The Journal of the American Medical Informatics Association (JAMIA). This study examined how clinicians at Alabama’s Huntsville Hospital decreased sepsis-related deaths by 53 percent during a 10-month period using a combination of clinical change management and electronic alerting from POC Advisor, a highly-accurate clinical decision support (CDS) software.
To learn more about this important implementation, we contacted Dr. Claypool, MD, Medical Director, POC Advisor, Wolters Kluwer.(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)
Claypool outlines how Huntsville Hospital and POC Advisor partnered to build upon the Institute for Healthcare Improvement’s (IHI) “Surviving Sepsis Campaign”.
Notable quote: “The core work that [Huntsville Hospital] wanted to do, and that we were going to do with them with POC Advisor, it was still built upon the IHI ‘Surviving Sepsis Campaign’ concept that nursing staff should be involved in the front line for the screening for sepsis, and if they identify sepsis, they should get the ball rolling.”
II. Addressing sepsis before POC Advisor
Claypool describes how care providers have traditionally dealt with potential sepsis cases. He goes on to describes how POC Advisor’s extensive studies of false positives have helped its rules engine.
Notable quote: “There are a lot of medical conditions … that cause SIRS, that cause lab abnormalities and vital sign abnormalities. [These diseases] would cause a traditional [sepsis] screen to be positive that really weren’t.”
The chief goal of this partnership with Hunstville Hospital, according to Claypool, was to focus upon the accuracy and speed of alerting nursing and physician staff relative to potential instances of sepsis.
Notable quote: “Our goal was our alerting would be very accurate, and so when nurses got an alert … they would believe it and call the doctor.”
IV. The challenges of interoperability
When discussing the planning and implementation of this project, Claypool cites “HIT infrastructure” and “hospital readiness” as the main challenges. He goes on to point out the critically important role change management played as well.
Notable quote: “The parts that were challenging really relate to HIT infrastructure of hospital readiness. The interoperability of healthcare data, the availability of discrete, codified terms of medical conditions, of medicines, is still a challenge.”
V. Components of the study
Claypool breaks down the JAMIA study into two parts: the accuracy of the POC Advisor alerting system (its sensitivity and specificity) and then a “before and after” of three wards at Hunstville Hospital relative to their sepsis detection.
Notable quote: “After we were comfortable that the alerting system was accurate… then we did a study. The study as a ‘before and after’ study … The number of deaths of patients [who] had sepsis dropped by 53 percent.”
VI. Awareness is still needed
Much like the heightened level of awareness and revised protocols around congestive heart failure patients, Claypool believes similar raised levels of interest along with diagnostic reconsiderations are required if we hope to find real, positive improvements with sepsis detection.
Notable quote: “Awareness is a big part of the goal of improving quality for sepsis care.”