There’s a reason that sepsis is known as a hidden killer. It can be hard to diagnose, there’s no one cause, and often, once the inflammatory response has taken hold, it’s too late. In fact, it’s the leading cause of death in U.S. hospitals, UCHealth included.
In 2017, a team at UCH implemented early recognition interventions to stave off the onslaught of sepsis symptoms that include fever, chills, an elevated heart rate, and difficulty breathing. A warning system, an alert team, which included a pharmacist to the process had dramatic results.
“The mortality rate was reduced by 12%,” said Dr. Jeff Glasheen, chief quality officer. That translates to 36 lives saved in the past two years. Plus, the critical time to antibiotics decreased from more than three hours down to 77 minutes. Glasheen was impressed but said, “we needed to do better.”
“We usually look to improve outcomes for an individual disease, such as heart failure or lung cancer,” said Glasheen. “We decided to look beyond the disease from a higher vantage point and implement big changes that would cross all diseases.”
One of the hurdles: the alert system that monitored pulse and other sepsis indicators was buried in electronic medical records. It might be two hours before a nurse accessed Epic, saw the warning and took action. To address that delay, a pilot program that leverages the power of the Virtual Health Center (VHC) was rolled out in the pulmonary unit in April.
The VHC is staffed by physicians, nurses and technicians who monitor patient vitals and labs. At the same time, advanced software factors in socio-economic data (for example, marital status), labs and vital signs and filters out points that produced false positives in the past. Any red flags and a direct call from the VHC to the bedside team escalates the issue. This triggers what Glasheen says is the most crucial step – human interaction.
“This system is totally dependent on the partnership between the bedside team and a human-to-human conversation with the VHC,” said Glasheen.
“While data is a huge predictive tool, it cannot and will never replace clinical acumen. A nurse, for example, will be aware that the patient just returned from PT – hence, the elevated heart rate If the bedside team concurs or supplements the findings with their own clinical input,” Glasheen said. “That’s when we’ve really moved the needle in terms of when we take action.” The ACE unit, MDSS, orthopedics, general surgery, transplant and others were phased into the VHC program over the summer. And while the final data is still being compiled, early results are show significantly earlier intervention in these critical ill patients.
“This process very immediately saves lives,” said Glasheen.