When CHS Director of Process Improvement Jerri Sutherland was asked to help clinical teams improve the identification and treatment of septic shock, she eagerly accepted the challenge.
The work was based on two, nationally-recognized facts about sepsis. First, every hour that a patient is in septic shock without receiving antibiotics increases mortality risk by 8% (per hour!) and, second, if clinicians are missing the sickest of septic patients, they are likely also missing patients with other, less severe forms of sepsis.
Hospital leaders and clinicians from Flowers Hospital in Dothan, Alabama, Northwest Medical Center in Bentonville, Arkansas and North Okaloosa Medical Center in Crestview, Florida agreed to join the program. All three hospitals used an Objective Problem Solving (OPS) methodology that enables teams to identify the cause of process failures, and then put measures in place to achieve better outcomes.
The results have been overwhelmingly positive. In just over three months, Flowers improved their one-hour antibiotic administration rate from 16% to 75%, North Okaloosa from 38% to 83% and Bentonville from 20% to 50%, and each market has plans and training in place to achieve continued improvement.
The key to these improvements varied by site, so each hospital’s process challenges required different tactics to achieve the improvement.
At North Okaloosa, for example, patients meeting sepsis criteria (2 SIRs plus a possible source of infection present) were triaged in the same room as the general patient population. By assigning all septic patients a yellow clipboard (for easy identification) and providing emergency department RNs with SpectraLink phones to expedite communication with receiving RNs, the hospital has surpassed the industry standard of 75% in compliance with the administration of antibiotics within one hour.
The team at Flowers standardized a new sepsis treatment tool consisting of a “blue sheet” questionnaire specifically designed to help identify sepsis and a simple egg timer that travels with a patient as they move from triage to treatment. Clinicians at Bentonville have been tackling the problem via daily sepsis huddles and real time triage adjustments.
According to Zachary Marden, Registered Nurse and Assistant Director of the Emergency Department at Flowers Hospital, simple solutions can make a big difference.
“Frontline staff engagement is critical to success, especially since the process opportunities are not necessarily isolated to new nurses – some of our veteran caregivers are benefitting from the more systematic communications and process refinements,” says Marden. “Thanks to our enhanced focus on sepsis, we now treat every patient like they are in severe sepsis until proven otherwise,” he continued.
In addition to their individual process improvements, the three hospitals are learning from each other, and will be sharing their learnings with others across the CHS organization.
Objective Problem Solving is being introduced to CHS affiliated hospitals – not just to improve sepsis protocols – but to establish a methodical and objective approach to problem solving for all kinds of improvement opportunities.
“The OPS methodology allowed us to see the longstanding challenge of sepsis through a new lens and will afford us the same opportunity as we look to enhance other quality-based challenges throughout the hospital,” concluded Marden.
Sutherland agrees and has already helped multiple facilities employ the OPS methodology to other applications. “We’ve used OPS to reduce OR turnover times, improve cardiac throughput, and reduce the number of cesarean births, to name a few,” said Sutherland.
“This simple training is going to have huge impacts on the organization and how its frontline staff goes about solving problems to enhance safety, quality and satisfaction.”
For additional information on the effectiveness of Objective Problem Solving in healthcare, consider reading On the Mend: Revolutionizing Healthcare to Save Lives and Transform the Industry by John Toussaint, MD and Roger A. Gerard, PhD.