INLP

The Project Purpose and Target

 

Following the successes of the INLP Medication Administration project, a 22-month long INLP Sepsis Improvement program was launched in June of 2008. Nine hospitals from the San Francisco Bay Area participated in total, including seven hospitals that had participated with the first INLP project on reducing medication errors. 

 

Participation was voluntary, and all associated training costs were covered by the grant. As with the Medication Administration project, commitment from senior leadership and a signed MOU was required from each hospital, with an expectation that chosen staff would fully participate, and finish the program. The project included:

• All general medicine units

• Step-down units

• Intensive care units

• Emergency department units

 

Project goals:

 

• 15% reduction in the mortality rate from severe sepsis through improved early recognition and treatment within 18 months

• Use of screening tool 95% of the time

• Use of “mini” bundle section of SSB/EGDT 85% of the time

 

An interdisciplinary steering committee of nurses, pharmacists, administrators, physicians, and laboratory directors was chosen from each hospital. This committee was responsible for oversight of the work done at the unit level, and driving the program hospital-wide.

 

Four core strategies were used to reduce sepsis mortality:

 

1. Each hospital attended a series of leadership training seminars.

2. Each unit was trained on the importance of identifying severe sepsis and septic shock. Sepsis screening of all patients was implemented, along with diagnostic testing according to protocol.

3. Teams implemented the “sepsis bundle” on appropriate patients. Timely treatment was based on key elements of Early Goal-Directed Therapy (EGDT), including: 

   • Obtaining a lactic acid level, and if elevated, or if the patient is hypotensive (or believed by the medical staff to be severely septic), then obtaining blood cultures

   • Obtaining a lactic acid level, and if elevated, or if the patient is hypotensive (or believed by the medical staff to be severely septic), then obtaining blood cultures

   • Administering fluids and antibiotics

   • Inserting a central line to measure patient response to therapies. (optional measure for this grant)

4. Ongoing data review: coded data was captured and submitted by each participating unit.

   • Final program measurement: April 2011

 

Sepsis cases and mortalities

 

Cases of sepsis and sepsis related mortalities were determined by using coded data reported by each individual hospital participant. Two analyses of the data were conducted to assess the relative improvement:

 

• In the first approach, data for 2008 and 2009 was annualized in order to best compare cost savings

• In the second approach, data was compared for July – December of each year

 

Case Mix Index (CMI) is a risk score that is assigned by CMS based on severity of coded cases. CMI was used for each hospital and applied by year, to adjust cost based on severity scores.

 

Cost methodology

 

To best determine the cost savings associated with Sepsis, an industry accepted base cost of $22,100 (in 2008) was used and escalated by 1% each year as increases in cost were estimated to be at most 1% each year*

 

• 2008 = $22,100

• 2009 = $22,321

• 2010 = $22,544

• 2011 = $22,770