Cross collaboration, early alerts lead to lower sepsis mortality rates

In early 2021, USA Health initiated a performance improvement effort aiming to reduce mortality by improving early identification and evidence-based treatment of sepsis. The goal was to reduce sepsis mortality by 10%, equating to approximately 18 additional sepsis survivors per year. The team set out to identify opportunities for system improvements that would support frontline staff providing evidence-based care to patients. This would be a huge umbrella project that would require cross-department collaboration among pharmacy, nursing, quality, information technology (IT) and physicians, and they would lean on Oracle Cerner technology and support to help it succeed.

USA Health first adopted Oracle Cerner technology in 2017. The incorporation of St. John Sepsis alert algorithm began in August 2021 while alert workflows and PowerPlans^TM with client-developed sepsis content were deployed in October 2021, in collaboration with Oracle Cerner. This enabled clinicians to manage orders and interventions specifically for patients who present with sepsis with the goal of improving patient outcomes. The sepsis alert algorithms, along with better workflow and alert response options, were aimed at facilitating near real-time patient monitoring, early identification and treatment of sepsis, as well as reducing alert fatigue. There was also an added focus for USA Health to monitor and understand its data to drive continual improvement.

“We did a lot of data analytics to gain understanding of our current state. Oracle Cerner’s Strategic Services, Value Advisory came on site and, together, we created a plan to incorporate changes in our EHR optimizing our end users’ workflow,” said Kristen Noles, performance improvement manager, USA Health. “The team determined that all decisions would be made by understanding our own data. We wanted to move from being reactive when harm occurs to a more proactive approach. Early detection supports better health outcomes.”

The data-driven Sepsis Performance Improvement team comprises a diverse representation of hospital departments to help oversee the adoption of workflow changes and decision support tools within the electronic health records (EHR). With this multidisciplinary group at the table, the team was able to learn and understand the system through a patient-centric view and the view of all caregivers supporting the patient. This allowed for the team to see all alerts, highlighting the ones that mattered by role, thus targeting the quality of the alert.

“After updating the sepsis PowerPlans, we were able to work with pharmacy, providers and IT on making first-dose antibiotic orders stat instead of routine. The change was an improvement for the care of all patients needing antibiotics, not just those with sepsis,” said Beth Leffard, manager, Quality, USA Health University Hospital.

With a sepsis alert, nurses can contact physicians when they have concerns that a patient could be developing sepsis. Once notified by nursing staff, physicians can select the appropriate antibiotic treatment using an embedded antibiogram, a tool that uses the local susceptibility pattern of pathogens to guide antibiotic choice. As of August 2022, with this new workflow and the implementation of Cerner documentation to align care teams, USA Health has reduced its sepsis mortality rate by 16.5%[1], which equates to approximately 28 additional sepsis survivors[2] on an annual basis.

“We have been impressed with the work USA Health has done to leverage Oracle Cerner solutions to support patient care,” said Bob Kopanic, senior vice president, North America Client Relationships, Oracle Cerner. “They came together as a system and a team to not only transform their internal workflow processes but to also amplify a culture of collaboration, continued learning and improvement. Oracle Cerner is proud to support USA Health as it supports the patient and caregiver experience within the health system.”

Collaboration is the culture of care at USA Health. The proven success and team ownership achieved with the implementation of the Oracle Cerner products led to a new goal to reduce sepsis mortality by an additional 10% by the end of 2022. USA Health will also incorporate lessons learned from its sepsis efforts to implement similar care transformations in other projects, as well as guide efforts at USA Health Children’s & Women’s Hospital and other locations to reshape caregiving plans for sepsis patients.

About USA Health

USA Health is the only academic health system along the upper Gulf Coast. With nearly 30 care delivery locations, including USA Health University Hospital, USA Health Children’s & Women’s Hospital, USA Health Mitchell Cancer Institute, and physician practices sites throughout the area, the health system melds clinical care, research and healthcare education into the most advanced medical care in the region.

About Oracle Cerner

Oracle Cerner’s health technologies connect people and information systems at thousands of contracted provider facilities worldwide dedicated to creating smarter and better care for individuals and communities. Recognized globally for innovation, Oracle Cerner assists clinicians in making care decisions and assists organizations in managing the health of their populations. The company also offers a connected clinical and financial ecosystem to help manage day-to-day revenue functions, as well as a wide range of services to support clinical, financial, and operational needs, focused on people. For more information, visit Cerner.com.

[1] Comparing sepsis mortality rate of 15.6% from April 1, 2020, through August 31, 2021 to sepsis mortality rate of 13.2% from October 1, 2021 through August 31, 2022.

[2] Comparing the annualized number of sepsis mortalities from April 1, 2020, through August 31, 2021 to the annualized number of sepsis mortalities from October 1, 2021 through August 31, 2022.