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Safety Net Hospital Protocolizes a Predicate-Linked Technology to Reduce Care Variation, Improve Outcomes, and Avoid Costs Related to Septic Shock

A 300-bed , Level 2 Trauma, teaching hospital and part of a large, high-performing health system was inconsistently meeting the sepsis quality benchmarks set by both the health system and CMS. As a designated safety net hospital and location within the inner city of a major metropolitan area, the hospital provided healthcare for all population including an underserved population often presenting with untreated and unknown comorbid conditions.

Severe Sepsis and Septic Shock totaled more than 850 cases per year, and the hospital was challenged with an ICU Length of Stay (LOS) and sepsis mortality rates higher than the national average. Sepsis remains the most expensive reason for hospitalization in the U.S. One key element of the Septic Shock Early Management Bundle is timely and effective use of IV fluids. Despite meeting other recommendation set out in the sepsis bundles, fall-outs associated with fluid resuscitation are commonly associated with the inadequate fluid administered or the failure to perform and document a fluid re-assessment within the recommended time. 

CASE STUDY

Objectives

Improve clinical outcomes related to septic shock through a combination of protocolization, technology, and intense education and training 

Quantify the changes in Sepsis Performance Measures between the study and baseline periods

Reduce the overall costs to the hospital for the treatment of septic shock by implementing an evidence-based volume resuscitation strategy

CASE STUDY

Key Measures

  • SEP-1 Bundle Compliance

  • Septic Shock 6-hr Bundle Compliance

  • Sepsis Screening Compliance

  • New Onset Mechanical Ventilation

  • New Onset Renal Replacement Therapy

  • Time Zero to Blood Culture

  • Time Zero to Antibiotic Given

  • Time Zero to Lactic Acid Collection

  • Blood Culture to Antibiotic Given

  • Implementation of a technology-driven fluid management strategy contributed to a decrease in ICU ALOS, new onset dialysis, and mechanical ventilation

  • Intense training and education raised the awareness on practice variation. This led to higher rates of sepsis bundle and screening compliance

  • Giving less fluid contributed to better patient outcomes and a cost-avoidance of over $11K per treated patient

Results

CASE STUDY

CASE STUDY

Background

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