sepsis: process improvement and our quest for excellenceand sepsis notes were developed in the ed...

Sepsis: Process Improvement and Our Quest for ExcellenceNYP-Brooklyn Methodist Hospital

October/November 2017

NYS PARTNERSHIP FOR PATIENTS

NYP-Brooklyn Methodist Hospital○ We are a 591 bed teaching hospital in Brooklyn, NY○ We saw 107,133 patients in our ED last year○ We have a culturally and socioeconomically diverse

patient population○ We care for a large number of SNF patients



Hospital Sepsis Team – An Evolution○ Original 2011 Team Current 2017 Team○ Steve Silber, MD, VP QIPS Barbie Gatton, MD, QI ED○ Joe Bove, MD Chair EM David Conner, MD, IM QI○ Larry Melniker, MD, Vice Chair EM Ashley McNamara, RN ○ Barbie Gatton, MD, Director of QIPS ED Natalia Maximovsky, RN Crit Outreach○ Mary Magee, RN MBA, EM Nursing Anna Donnelly, RN, Nursing Dir. ED

Anna Donnelly, EM Nursing Susana A. Soto Vinas Nardone○ Eddie Luciano, Lead PA Nick Vaccari, MD Medical Dir. ED○ Gary Wu, Pharmacy David Li, Pharmacy○ May Jabra, Pharmacy IT Katherine King, QI○ Infection Control Suzanne Avelini, Infection Control○ Damian Zambrana, Admitting Zaikya Mills, RN, IT○ Senior EM resident Verlinda Cortez-Guanga , QM○ Blanche , RN, Hospital QI Department Liziamma George, MD Critical Care○ Liziamma George, MD, Critical Care Tom Russi, MD CDI○ Shari Torres, RN, PhD



Inspiration



Project Description○ Began Sepsis initiative in 2011.○ 2013-2015 IT Crawler with Staff trained on the treatment

protocol.○ 2016 ED Sepsis Codes began. Rapid cycle PDSAs were

employed to target specific performance measures. We improved in timely lactates and blood cultures. We went through several cycles of IV fluids interventions. PowerPlans and sepsis notes were developed in the ED were reformatted for inpatient and introduced to medical residents. A feedback system has been developed so these issues remain on the top of residents’ minds.

○ In addition, in 2016 we addressed erroneous sepsis coding. A process was developed with CDI to ensure accurate coding

○ In 2017, Revamped sepsis codes include streamlined processes, improved PowerPlans, as well as more inclusive interdisciplinary response. October/November 20175


2107 Project Implementation○ Began in ED ○ New Sepsis Protocol○ Built Order set for physicians○ Check list for nurses○ Sepsis Box ○ Educational campaign that included lab and

pharmacy as well as nurses, APPs, and doctors○ Individual Performance Feedback○ Continual Education at huddles and conference



Tools & Resources



Feedback Tool



Successful Strategies &Tips○ Simplified Process○ Real Time Decision Aids (pocket cards, checklist)○ Frequent PDSA cycles○ Constant Feedback



Challenges & Barriers○ Large and changing staff○ Technical Issues: Lactate: critical value,

transmission, cancelation of repeat lactate○ IV fluid documentation: multiple rounds of

interventions prior to success○ Accurate & timely tissue perfusion

documentation○ SIRS developing after initial presentation○ Complexity of the disease○ Confusion over details of the regulations



Key Lessons Learned○ Frequent PDSA cycles○ Refine tools/process as needed○ Pocket cards and checklist!○ Constant education○ Focus on common pitfalls○ Develop and encourage champions



Outcomes & Data

71%

46%40%

44%

0%

20%

40%

60%

80%

100%

NYP Brooklyn MethodistCompliance Rate

Truven's Average Rate(out of 414 hospitals)

NY State Average National Average

Q1-2017 SEP-1 Bundle Comparison



Steps for Hardwiring & Spread○ Hope to go live hospital wide in the next few months○ Will continue education with all staff○ Will refine our tools as needed○ Foster more champions



Contact Information○ Barbie Gatton, MD○ Director of QIPS for the Department of

Emergency MedicineNYP-Brooklyn Methodist [email protected]


mailto:[email protected]

sepsis: process improvement and our quest for excellenceand sepsis notes were developed in the ed...

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