Tackling sepsis calls for quick, efficient protocols. For Michael W. Fill, DO, emergency physician at Henry Ford Health in Jackson, Michigan, this meant empowering nurses in the emergency department to fast track the process on lactates.
“We have a nurse-driven protocol where if the patient screens positive…that they actually advance order a lactate and send it up to the lab,” said Dr. Fill, who chairs the Henry Ford Health Jackson Hospital Sepsis Committee. If the value of that lactate is greater than 2 millimoles per liter, the nurse calls the physician assigned to that patient and “huddles” with the doctor at the bedside.
“The three things that we discuss are the IV [intravenous] fluids, the antibiotics and the next steps for the patient,” said Dr. Fill, who joined other leaders at Henry Ford Health during a webinar that addresses action elements physicians and other health professionals can take to recognize and treat sepsis. Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The Henry Ford Health experts presented during the third part of a webinar series on the Centers for Disease Control and Prevention’s Hospital Sepsis Program Core Elements, which can help health care facilities implement, monitor and optimize their sepsis programs and outcomes. This free continuing education webinar series was developed in collaboration with the AMA and CDC’s Project Firstline.
The CDC estimates that about 1.7 million adults in the U.S. develop sepsis each year, and at least 350,000 die from sepsis annually.
CDC’s seven core elements offer a blueprint to hospitals for building a successful sepsis program. “Action,” one of the core elements, is about creating a screening process, standardizing management through tools like an electronic order set, and developing processes to promptly deliver appropriate antimicrobials, said Erica Kaufman West, MD, who is the AMA’s director of infectious diseases and moderated the webinars.
Such action involves fluid and effective handoffs between health professionals and training rapid-response teams to recognize and intervene when patients develop sepsis, such as using a code sepsis protocol. Peri- and post-discharge patient care are also essential in helping patients recover and helping their families cope with possible long-term consequences, Dr. Kaufman West said.
Priorities for successful implementation
Experts presenting during the webinar said that hospitals implementing the action element should:
- Ensure that this process is well integrated into the existing clinical workflow.
- Consider newer tools such as machine learning tools to avoid projecting bias by gender, race, or ethnicity in the rollout of these algorithms.
- Have a hospital guideline for sepsis management that addresses screening, clinical evaluation of patients at risk for sepsis or with suspected sepsis, diagnosis of sepsis, and recovery-based practices to set up patients for longer term recovery and best outcomes after sepsis.
- Have structures and processes to facilitate prompt delivery of antimicrobials, such as stocking common medications.
- Develop rapid-response teams that are trained specifically to recognize and manage patients with sepsis.
What action looks like on the ground
Several representatives from Henry Ford Health discussed their experiences with the action core element at their respective institutions.
Megan Cahill, DO, division chief of medicine at Henry Ford Macomb Hospital, was joined by Errin Couck, BSN, RN, clinical quality facilitator for Henry Ford Health and HMS sepsis abstractor for Henry Ford Macomb Hospital. They discussed the action element as it relates to patient discharge and home care coordination.
The case management team is a big part of this, said Dr. Cahill. “This is our inpatient case management providers that work in the hospital setting. They will help determine if the patient needs assistance in scheduling their outpatient primary care appointments upon discharge.”
The team then connects with a hub that’s part of Henry Ford Health’s population health division. Coordinators in this division will schedule post-hospital primary care appointments for patients diagnosed with sepsis. Patients in turn will receive all the appointment information and education that they need upon discharge.
A hospital contact number offers a lifeline to the hospital if the patient has concerns that arise between the time they're discharged and when they're able to follow up with their primary care physician, said Dr. Cahill.
Efficiency is sometimes a small step
Sometimes there’s a need to troubleshoot and pivot.
When Dr. Fill’s team first implemented their nurse-driven protocol, they noticed there was still a big delay in antibiotic administration.
“One of our residents actually did a little project on that and found that many of the antibiotics that we were using weren't actually located in the Pyxis,” said Dr. Fill, referring to the Beckton, Dickinson & Co. bedside medication-dispensing system used. To solve the issue, his team identified the most used antibiotics and made sure they were available in the dispensing system so they could be administered quickly.
