Collaborating to Defeat Sepsis

On Monday, February 6, sepsis initiative facilitators from across UNC Health Care met in High Point to discuss the latest initiative results from each system hospital. Held every 90 days, these gatherings highlight the importance of collaboration in defeating sepsis at our hospitals.

Collaborating to Defeat Sepsis click to enlarge Core sepsis initiative members from across UNC Health Care gathered in High Point in February to discuss initiative results and brainstorm ideas for continued improvement in sepsis care.
Collaborating to Defeat Sepsis click to enlarge Facilitators broke into small groups to identify data that would be helpful for them to capture and consider best methods for capturing and sharing that data.

by Zach Read - zachary.read@unchealth.unc.edu

Early in February, UNC Health Care sepsis initiative facilitators from each system hospital gathered at Millis Regional Health Education Center, across the street from High Point Regional Hospital, to discuss initiative results and brainstorm ideas for continued improvement in sepsis care. 

Although core sepsis team members from each hospital collaborate frequently throughout the year, these quarterly meetings have become critical for reviewing progress and for planning for the next one to three months – from the time of the meeting – in UNC Health Care’s journey to decrease mortality in sepsis patients of all ages.

“These larger, in-person gatherings provide opportunities for us to gauge where we are as hospitals and as a system, share our successes and failures, and consider ideas that can help each hospital improve sepsis treatment,” said Tina Schade Willis, MD, Associate Chief Medical Officer for Quality at UNC Hospitals, a physician in the Pediatric Intensive Care Unit at the North Carolina Children’s Hospital, and leader of UNC Medical Centers’ sepsis reduction initiative, Code Sepsis.

In High Point, facilitators from each hospital presented on sepsis-initiative accomplishments made in the last 30 days; initiative work they will embark on over the next 30 days; decisions their teams have made to improve processes; and risks they’ve identified.

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At the October meeting at Chatham Hospital, representatives shared research projects related to sepsis. Hands-on simulation is making a difference in sepsis response times.

While facilitators learn from each other’s experiences, they’re aware that no one-size-fits-all model exists for hospitals’ treatment of sepsis.

“There is no gold standard test to diagnose sepsis, which complicates early identification and the reporting of our progress,” said Schade Willis. “Collaborative learning is helpful in moving past these complexities because many hospitals across the nation are working toward the same goal and have learned valuable lessons along the way.”   

The key focus of the High Point meeting was to identify ways to improve and standardize sepsis-data collection across the health-care system. Led by Matt Huemmer, MBA, MHA, project manager with the Institute for Healthcare Quality Improvement (IHQI) at UNC, sepsis facilitators broke into small groups, identified data that would be helpful for them to capture, and considered best methods for capturing and sharing that data.

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At the October meeting at Chatham Hospital, representatives shared research projects. The Family Sepsis Education Initiative seeks to educate 500 patient families whose children are at higher risk of onset of sepsis.

“Each entity has its own unique set of challenges in achieving improved recognition of and response to sepsis,” said Huemmer, who is serving as project manager for the sepsis initiative. “For example, not every hospital is on Epic@UNC yet, but we’re finding that by working together, we can come up with shared measurements that can help each other achieve our goals.”

Huemmer joined UNC Health Care in November 2016 after years working in project management in the pharmaceutical industry and with companies such as Quintiles, PPD, and UCB. His skillset promises to help build cohesion among system entities in their quest to decrease sepsis mortality.

“Matt has joined us to bring additional improvement coaching assistance and program management to this very large collaborative group,” said Schade Willis, who also serves as director of IHQI. “Mortality reduction, with a focus on sepsis, is a long-term program that touches thousands of patients in our system. It requires ongoing monitoring, targeted improvement efforts aimed at gaps in performance, and effective communication. Matt’s experience as a Lean Six Sigma Black Belt working with large teams adds a centralized coach for the program that will work with the teams at each hospital.”

Within the past year, the group has also included the addition of Kara Shore, the Epic@UNC project manager for the sepsis initiative. Shore has coordinated the meetings – and more importantly, she’s led her Epic@UNC team in tool development and optimization for end users, an ongoing necessity for the hospitals on Epic@UNC.

“Kara Shore, Daniel Licatese, and the entire Epic@UNC team working with the sepsis program are invaluable in moving us forward as evidence-based recommendations are updated over time," said Schade Willis.  "With such a complex and inexact disease process, we must have multiple options for doing the right thing for the right patients at the right time."

These larger meetings also bring together an interdisciplinary group of health-care professionals with different experiences in sepsis diagnosis and treatment – in fact, seven individuals from High Point Regional Hospital alone attended the February meeting, including physicians and nurses from the intensive care unit, general medicine and neurovascular floors, and the emergency department.

Through the quarterly gatherings, facilitators have been able to make consensus recommendations regarding electronic health record tools, educational materials, and partnerships with patient and family advisors. In October 2016, facilitators met at Chatham Hospital, where they listened to presentations by UNC Hospitals pharmacist Ashley Marx, PharmD, BCPS, Assistant Professor of Clinical Education at UNC Eshelman School of Pharmacy, who oversees the medication preparation for patients identified as septic; Hillary Spangler, UNC medical student, sepsis survivor, and co-principle investigator for the Family Sepsis Education Initiative at UNC Hospitals, an effort to educate 500 families of pediatric patients at higher risk of sepsis onset; and others.

During each of the four meetings held so far, facilitators have shared success stories. In February, facilitator Keith Stinson, nurse from Chatham Hospital’s Emergency Department, described a septic patient they identified quickly and transferred to UNC Hospitals; Christy Davis, facilitator at Johnston Health, noted that length of stay had decreased significantly, a sign that caregivers are recognizing sepsis earlier than before the initiative started; and facilitator Teresa Sumner, of Lenoir Memorial, reported an increased level of knowledge in the identification of sepsis among emergency department personnel.

For Sumner, the meetings have been helpful because they’ve connected her with colleagues and resources from other system hospitals.

“When you’re a smaller hospital, as we are, a meeting like this is a fantastic resource,” Sumner said. “After you’ve met your colleagues at these meetings, you’re more comfortable picking up the phone and calling them to exchange information on what each of you is seeing and doing to combat sepsis.”

Patrick O’hearn, facilitator from High Point Regional, has seen improvements from this collective effort.

“In the last 30 days, we’ve started a checklist in the ED and the ICU,” he said. “The checklist is making a difference – we’re saving lives.”

In addition to creating goals around data measurement standardization, facilitators left February’s meeting with several objectives to be achieved in the months and year ahead, including enhancing sepsis education efforts, improving feedback for clinicians, and standardizing use of ‘Code Sepsis’ calls at more system hospitals, among other plans.

Christy Davis reported that Johnston has had huge success with sepsis bundle compliance, with particularly high marks achieved in January, and that cooperation has increased as understanding of the seriousness of sepsis has grown among caregivers.

“We’ve been building awareness at Johnston,” she said. “People understand what we’ve been communicating with them – ‘Sepsis waits for no one. What we do matters.’”

This key message – that sepsis waits for no one – is exactly what makes decreasing mortality across so many different hospitals challenging. But it also pushes facilitators toward the kind of collaboration that has been saving lives at UNC Health Care.

“Sepsis is non-discriminatory,” said Schade Willis. “It affects all age groups, in many different areas of a hospital. That’s why collaboration is so important. We are building a tremendous collaborative culture through this program and have countless stories of patients that have been identified early with sepsis, received a rapidly delivered sepsis treatment bundle by teams in the emergency departments, inpatient units and clinics in under 60 minutes, and been successfully discharged from the hospitals. We are now detecting decreases in overall mortality and sepsis mortality in many of our hospitals.”

For more information on Code Sepsis, visit the Code Sepsis page. Other UNC Health Care sepsis stories include: