The Centers for Medicare & Medicaid’ (CMS) sepsis bundle is a test for a hospital’s preparation for and ability to navigate the future of healthcare. Released in October of 2015, the sepsis bundle is far more complex than previous CMS quality metrics. It requires hospitals to produce longitudinal, detailed reporting on patient care spanning multiple departments. In most cases, these departments are not used to working closely enough in order to satisfy the bundle requirements. As a result, our anecdotal evidence suggests compliance nationwide averages somewhere around 30-40%.
Part of the problem is of course the existing model of using different specialty physicians groups to staff disparate departments. These groups often struggle to execute on initiatives which require this kind of coordination. In my past experiences, I’ve often seen a lack of physician leadership – and more specifically, a lack of a single, accountable team to take ownership over the process – lead to failure, despite the best of intentions to improve patient care.
There are more than 1 million cases of sepsis per year, according to the National Institute of General Medical Services, which estimates that between 28 and 50 percent of those people die. This is more than deaths from prostate cancer, breast cancer, and AIDS combined. It’s clear that an effective response to sepsis is essential for improving population health and lowering mortality rates.
It is within this context that US Acute Care Solutions created its Integrated Acute Care (IAC) model. Besides unifying care across different departments, the integrated model supplies the missing component to ensure that programs like the sepsis bundle initiative succeed: accountability. With Integrated Acute Care, a unified team takes ownership over process improvement, and is held accountable for its success – or failure.
The implications of this model are on full display at our IAC location at Somerset Hospital in Somerset, Pennsylvania. From the start, USACS’ collaborative model of managing both the Emergency Department and Hospitalist services laid the groundwork for success. The team there implemented a sepsis bundle program which included four essential components:
- A Unified Interdisciplinary Team. USACS formed a process improvement team which brought together representatives from key departments throughout the hospital, including pharmacy, radiology, lab personnel, the documentation team, hospital quality leaders, the CNO, and APP leadership. The collaborative approach allowed us to diagnose areas for improvement while remaining accountable for moving the program forward.
- Outreach and Education. A key cornerstone of any process improvement, USACS embarked on an aggressive campaign to help nursing staff and physicians identify potential sepsis presentations.
- Identifying Areas of Fall-off. Over the course of several weeks and months, USACS used hospital data and input from the interdisciplinary team to identify several areas of improvement. Among the improvements:
- Installing an automated process to ensure a second lactate test is drawn within 6 hours of presentation if the initial lactate level is >2. Previously, there had been a fall-off on ordering repeat lactates.
- Changing the sepsis order set and educating staff to ensure proper anti-biotic selection in order to meet the bundle metric.
- Creating a set guideline for proper dosing of fluid resuscitation.
- Continuing Education & Monitoring. With the program in place for a year, USACS still monitors its compliance to ensure areas of small drop-offs. When identified, USACS works with its interdisciplinary team to correct.
In January of 2016, when the program began, Somerset Hospital was 0% compliant with the sepsis bundle requirements. Within a few months, compliance was up to 50%, and within 6 months compliance had reached 75%. In months 6-12 after program implementation the Integrated Acute Care Team was able to maintain sepsis bundle compliance between 60% and 75%.
With healthcare continuing to shift from volume to value, and reimbursements increasingly tied to quality metrics, the success of the sepsis program at Somerset is an example for other hospitals and health systems to emulate.