Advances in technology change the way we practice medicine and treat patients. Staff at UF Health Jacksonville started a program that uses software to combat sepsis, a common and deadly infection.
“Sepsis is the way your body is trying to cope with a severe infection that gets into the bloodstream and induces a state of shock,” said Faheem Guirgis, MD, an emergency medicine specialist.
It is an ongoing problem throughout hospitals nationwide, but UF Health Jacksonville’s commitment to quality and patient safety has positively impacted sepsis rates with the help of innovative technology.
“We are utilizing our electronic medical records, or EMR, to help with our quality goals,” said Kelly Gray-Eurom, MD, chief quality officer and emergency medicine specialist. “We use EMR software EPIC to track a patient’s condition, treatment and medication information.”
Sepsis is a life-threatening response to infection that can destroy tissue and damage organs in a matter of minutes. Sepsis can cause a number of symptoms, such as vomiting, sore throat, fever, cold intolerance, extreme pain, clammy skin, confusion, shortness of breath or high heart rate.
“Not everybody presents all of the symptoms, but those are some of the signs you will see,” Guirgis said. The number of possible symptoms makes sepsis difficult to diagnose.
In January 2014, a group of hospital staff started the Sepsis Program Protocol. Lisa Jones, MD, medical director of the Medical Intensive Care Unit; Carol Fultz, director of Nursing Services; Cynthia Gerdik, director of Critical Care Nursing; Alice Weiss, performance improvement specialist; and Rhemar Esma, quality measures abstractor; worked with Gray-Eurom and Guirgis to improve sepsis rates throughout the hospital.
“We knew that we had to have a protocol for each area — the Emergency Department, the floors and the units,” Guirgis said. “But we wanted something that we could really generalize to all of those areas.”
The group started by using the capabilities EPIC already had in place. The software helps with the early recognition of infections by monitoring vital signs and sending alerts when there are factors present that indicate sepsis. Then Esma created a program in Excel that works in the background of EPIC, pulling vital signs and lab values every hour for each patient in the hospital.
“When the patient meets certain criteria, an alert goes to the doctor, and the doctor can go to the bedside to assess the patient,” Gray-Eurom said. Once the initial alert goes out, the goal is to begin the treatment process of administering antibiotics and fluids, and drawing blood cultures and lactates within the first three hours.
The protocol is based on the modified early warning signs sepsis response system. The group analyzed the criteria, which is typically used in an ICU setting, and adjusted it to apply to the entire hospital. From January 2014 to March 2016, sepsis rates dropped by 30 percent. “We lowered our inpatient mortality after starting the program,” Guirgis said. “We also reduced the length of stay for both the intensive care and inpatient units, and reduced the need for patients to be on a ventilator.”
The team isn’t stopping there. They are also working toward integrating a recognition tool into EPIC and possibly including a risk calculator. This would allow a clinician to enter in a diagnosis of sepsis, and the program would calculate the patient’s potential mortality rate based on vital signs and lab work. “This will help determine where the patient needs to be and the level of monitoring and care that they require based on their sepsis diagnosis,” Guirgis said.
The Sepsis Protocol Program has been a highly successful effort. The team worked with staff members from every department of the hospital to ensure this protocol would work seamlessly with existing programs.
“The thing about sepsis is that it involves every part of the hospital, every specialty, and anybody at any time can take care of a septic patient,” Guirgis said. “It’s nice because it allows us to work with everyone, and we’re all working toward the same goal of improving care for patients with sepsis.”
Kelly R. Gray-Eurom, MD, MMM, FACEP
Chief Quality Officer, UF Health Jacksonville; Assistant Dean for Quality and Safety; Associate Chair and Director, Business Operations, Department of Emergency Medicine
Faheem W. Guirgis, MD, FACEP
Program Director, Emergency Medicine and Acute Care Research Fellowship; Director, Center for Research Training