Dr Nic WoodsPhysician Executive, Cerner ANZ
Using the EMR inearly recognition and
management of sepsis
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fully digital hospital and HIMSS Stage 6 in
Hervey Bay
Topics
• The challenge• Some tools• Some outcomes• Key points • Questions
Topics
• The challenge• Some tools• Some outcomes• Key points • Questions
Sepsis – what is it?
Sepsis – what is it?
The challenge – Global burden
From World Sepsis Day Organisation;. www.world-sepsis-day.org
The challenge – Severe Sepsis, ANZ ICU’s
Kaukonen, KM et al. Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012. JAMA. doi:10.1001/jama.2014.2637
The challenge – Health system burden (USA)
Torio CM, Andrews RM: National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet] Rockville (MD): Agency for Health Care Policy and Research (US) 2006-2013 http://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp
#1 in 2011 for USA hospital costs
>$20 billion (5.2% of national costs)
The challenge – It affects many of us
Topics
• The challenge• Some tools
• Sepsis predictive model• EHR clinical decision support & workflow
• Some outcomes• Key points • Questions
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
• Predicted Operating Characteristics for the St. John’s Sepsis Alert (n = 68,962 encounters)
Scenario Encounters with Sepsis
Encounters without Sepsis
TruePositives
False
Negatives
False
Positives
True Negatives
Sensitivit
y
Specificit
y
PositivePredictiv
eValu
e
Negativ
ePredictiv
e Valu
eAll Cases 2,457 910 15,142 50,453 0.73 0.77 0.14 0.98
Some tools – Sepsis predictive model
Some tools – Sepsis predictive model
Operating Characteristics• Sensitivity 68-91%• Specificity 91-97.6%• PPV up to 68%
Alert fires when system finds3 signs of systemic inflammatory response syndrome, OR2 signs of SIRS + one sign of organ dysfunction
Topics
• The challenge• Some tools
• Sepsis predictive model• EHR clinical decision support & workflow
• Some outcomes• Key points • Questions
Some tools – EHR CDS and workflow
Some tools – EHR CDS and workflow
Some tools – EHR CDS and workflow
Some tools – EHR CDS and workflow
Topics
• The challenge• Some tools
• Sepsis predictive model• EHR clinical decision support & workflow
• Some outcomes• Key points • Questions
Some outcomes - Implementation
Monitoring>1 million lives> 490 facilities31,250 alerts received per hour748,250 alerts received per day
Some outcomes – Published evaluations
• Multicenter retrospective study, 6,200 patient records • Evaluation by CDS in silent mode with chart evaluation • 195 patients activated alert before sepsis suspected vs 417 patients activated
alert after provider recorded suspected sepsis • Median time from arrival to CDS activation was 3.5 hours, and system
activation to diagnostic collect was another 8.6 hoursAmland, RC, Hahn-Cover, KE. Clinical Decision Support for Early Recognition of Sepsis. American Journal of Medical Quality, November 2014. Available at http://ajm.sagepub.com/content/early/2014/12/10/1062860614557636.full.pdf+html
Some outcomes – Health service evaluations
Since 2010, 1980 lives saved (↓ mortality rate by 4.2%)
In FY2014, 156 lives saved (↓ mortality rate by 1.42%)
1 patient every 2 days
Mortality ↓ 17%. LOS ↓ from 16.5 to 13.6 days
Some outcomes – Health service evaluations
Some outcomes – Health service evaluations
Topics
• The challenge• Some tools
• Sepsis predictive model• EHR clinical decision support & workflow
• Some outcomes• Key points • Questions
Key points
• Sepsis – it’s nasty & not going away• Predictive models implemented back into the clinical workflow
can impact clinical outcome• We do well, but more to be done
Key points
Key points
Key points
Topics
• The challenge• Some tools
• Sepsis predictive model• EHR clinical decision support & workflow
• Some outcomes• Key points • Questions
Health care is too important to stay the same.
TM