Improving Sepsis Care, Saving Lives: Thoughts From Terry Andrus, CEO of East Alabama Medical Center
East Alabama Medical Center in Opelika, Ala.
On Christmas Eve, a young woman was admitted to the emergency department at East Alabama Medical Center. She was quickly diagnosed with sepsis, a dangerous, life-threatening infection. Instantly, a team of clinical staff members performed a series of sepsis care best practices to treat her. She was discharged from our hospital within four days and has made a full recovery.
Three years ago, her prognosis may not have been so favorable. In fact, she may not have even survived. As the CEO of EAMC, that's not an easy statement for me to make. But each year, 750,000 people nationwide acquire sepsis infections, and between 20 to 60 percent of them die from it. Sepsis has such a high mortality rate because the infection can begin in many different parts of the body and present a wide range of symptoms, which makes it difficult to diagnose and even more challenging to treat quickly. And with sepsis, speed is essential — if the infection goes untreated for too long, it can lead to permanent organ damage, shock, and in far too many cases, death.
Part of the problem with sepsis is that too few hospitals know how to diagnose the infection quickly, and even fewer have in place standard, rapid response protocols for fast treatment. EAMC was no exception to this rule. However, we took an important step that has helped us improve our sepsis care, reduce our mortality rates and improve our patient experience scores — all while cutting unnecessary costs.
Three years ago, we joined the Premier healthcare alliance's QUEST collaborative. Through this program, we were able to compare ourselves to similar facilities across the country to learn exactly how our outcomes stacked up against others. We saw what other hospitals were doing with sepsis care and how they had dramatically lower mortality numbers as a result. Seeing that we could improve outcomes for our patients — and that there were examples we could learn from — was a tremendous motivator for us. We didn't want to be an average performer — we wanted to be the best.
So, we made changes. We stopped talking about our sepsis mortality rate and started talking about the number of deaths that we could have prevented. This motivated our clinical teams and put very real, human faces to our work. After all, we're not in the business of lowering a number — we’re in the business of saving lives.
We also leveraged the collaborative to find top performing hospitals and learn what they were doing to reduce sepsis mortalities. In particular, we learned top performers had implemented a sepsis care bundle, which standardized exactly how clinical staff should screen for sepsis, respond quickly and manage it until recovery.
While learning about and implementing a best practice care bundle may seem like an easy thing to do, it isn't. Clinical staff needs to be trained on best practices and understand the evidence behind the interventions. Doctors and nurses need to be trained on the proper care protocols, when they need to be implemented, and the patient populations they affect. Clear chains of command need to be established so that everyone charged with providing care knows who should initiate the interventions and under what circumstances. And all processes need to be documented so that others understand what’s been done and what's left to do, particularly at shift changes. All this can require months of time for training and practice, and even longer to be hard-wired into the system so that it becomes standard operating procedure.
But when it works, it really has an impact. At EAMC, our focus on sepsis and other drivers of mortality has saved 163 lives. In sepsis care alone, EAMC's mortality rate has dropped 71 percent. And because we've been able to provide this care more efficiently — avoiding complications, misdiagnoses and readmissions — this work has also had a cost benefit, helping us save more than $34 million over three years.
A lot of work from staff and physicians went into EAMC becoming a top performer in the QUEST collaborative. When we first joined QUEST, I believed it would be beneficial, but I would not have predicted that we would reach the standards we routinely meet today. We have proven that significant change is possible with time, effort and commitment. And the rewards are well worth it — just ask that young woman who avoided death on Christmas Eve, or the 163 other patients who are alive today.
Terry Andrus is the president and CEO of East Alabama Medical Center in Opelika, Ala.
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