Achieving top quartile performance in sepsis mortality was an organizational-wide imperative at integrated health system WellSpan Health, with leadership support across the organization. The training strategy was developed at the organizational level with the intent to cascade it downward and upward to address unique learning needs and barriers experienced at various levels.
Healthcare providers and employees experience a multitude of “alerts” in the electronic health record daily. This can result in “alert fatigue” in that they do not stand out as critical to look at. To assist with this, WellSpan established a Central Alert Team to monitor the alerts and proactively reach out to providers and staff to ensure the sepsis alerts are not missed, or not missed within the timeframe necessary to save lives.
The Sepsis training plan included four leading components to train internal team members:
1. Training the newly created Central Alert Team, which was a brand-new concept at WellSpan.
2. Training physicians to understand the role of the Central Alert Team and the alerts themselves.
3. Training bedside nurses on the role of the Central Alert Team, the alerts, and the value the change brings to patient care.
4. Training the Pharmacy team on the importance of delivering sepsis-related medications through the electronic health system order on a timely basis as determined by Evidenced Based Practice (EBP).
Training occurred through a blended approach of group settings, classroom, on the clinical unit/floor, and through e-learning. E-learning modules were developed to provide a foundation of knowledge, customized by role in relation to sepsis. Each hospital ran a sepsis group to discuss barriers to achieving sepsis bundle compliance. Lessons learned included the fact that education and decision support for a bedside team are critical for success.
This new care model design—including the education and accountability elements—is replicable as it consists of a remote telemonitoring team of specially trained registered nurses (RNs) and custom alert algorithms. Learning strategy was woven throughout the plan and involved a champion senior physician leader who remains committed to it. The plan was designed to provide support from the organizational perspective (e-learning), the entity/hospital, and the bedside, as well as support change management by sharing the “why” throughout the training approaches.
A reinforcement tool known as “the scorecard” is helping WellSpan maintain its improvement in clinical outcomes and expand the scope of its performance measures in the short and long term. Each week, a report is sent to each operating unit with its Patient Sepsis Results. The report includes specific care team and individual performance outcomes, adoption of the process bundle, and what was missed. The vice president of the Medical Services Line reviews the report and e-mails specific departments or individuals with feedback. This may be related to an opportunity for improvement or recognition of great work.
A culture shift occurred over the first 6 to 12 months after implementing the new Central Alert Team. Level 3 behavior change results measured to what degree employees were applying the new process bundle. December 2018 sepsis bundle compliance for all acute hospitals ranged from 80 to 97 percent. The average screening time for sepsis alerts decreased by more than 50 percent to 12.12 minutes.
Year-end data demonstrated that WellSpan Health teams exceeded the target measures and achieved top decile performance when benchmarked against like hospitals in the Premier Quality Advisor Cohort, which includes more than 3,900 U.S. hospitals. As a result of WellSpan’s organization-wide efforts, 227 fewer people died in its acute care hospitals when compared with baseline statistical performance. The “observed-to-expected mortality” (O: E) is a risk-adjusted measure of a hospital’s mortality. Fiscal year 2019 examples of data include one hospital having a target O: E of 1.02 and achieving a .54 O: E. Another hospital achieved .47 O: E, exceeding the target of .96 O: E.