Multidisciplinary team gives providers tools to fight sepsis

Sepsis is a potentially life-threatening condition that occurs when an infection someone already has, such as in the skin, lungs, urinary tract or elsewhere, triggers a chain reaction throughout the body and injures other tissues and organs. Without treatment, sepsis can rapidly lead to tissue damage, organ failure and death.

According to the Centers for Disease Control & Prevention (CDC), more than 1.7 million adults in the U.S. develop sepsis each year, and nearly 270,000 Americans die as a result. The CDC also estimates that one in three patients who die in a hospital have sepsis.

It is the third most frequently coded diagnosis at Michigan Medicine. 

In honor of World Sepsis Day, which was recognized last week, here’s a closer look at the valuable work being performed around sepsis at Michigan Medicine:

Defining sepsis

While sepsis can be a life-threatening condition, one of the primary challenges is that sepsis can present in many ways, which can make it difficult to identify.

“Sepsis is a concern nationwide, but it can be defined in different ways, making it difficult to identify patients who are septic,” said Jessie King, M.D., Ph.D., an associate professor of internal medicine and medical director of sepsis initiatives at Michigan Medicine. “In order to improve outcomes for septic patients at Michigan Medicine, we first needed to create a standard definition that can be used to accurately identify the patient population.” 

To help create this definition, a multidisciplinary team from Michigan Medicine worked with representatives from Health Catalyst, an outside technology firm that provides data and analytics technology and services to health care organizations. This group spent numerous weeks reviewing existing definitions of sepsis and modifying them to create one comprehensive definition.

“Now that we have a comprehensive, agreed-upon definition of sepsis, we can pull data on a larger patient population to analyze how effective our current tools are and provide guidance on how we can better screen, evaluate and treat patients with sepsis,” said King. “Thanks to the hard work of this team, our clinicians now have another tool in our fight against sepsis.”

Putting processes into practice

Utilizing this newly established definition, a team from the Quality Department worked closely with clinical partners, Health Information Technology & Services, and other partners to develop new processes and implement changes in MiChart that will help providers identify and treat sepsis earlier.

“Early identification and treatment is critical for improving outcomes in this patient population, but sepsis is not always easy to recognize because the symptoms are not always obvious and can be confused as symptoms of other ailments,” said Pat Posa, R.N., M.S.A., FAAN, quality and safety program manager for UH/CVC. “The new processes we have put in place will aid clinicians in early sepsis recognition by alerting them to patients who meet multiple criteria for having sepsis.”

The new processes include a predictive model in EPIC, the organization’s electronic medical record software, that can automatically identify patients who meet the definition for sepsis. The model uses 80 different variables, based on symptoms and information input by the provider, to determine if a patient has multiple symptoms of sepsis.

If the patient meets the criteria, MiChart will automatically send a page to the patient’s nurse, who will screen the patient for sepsis and if a positive result is identified the provider will be immediately be paged.

“While some of these processes had been piloted on several units for more than a year, they were supposed to be more widely implemented months ago,” said Posa. “But, like so many other things, that plan was postponed due to the COVID-19 pandemic. Fortunately, we were finally able to introduce them on several adult inpatient units in late August and early feedback from nurses and providers has been overall positive.”

The hope is to give clinicians all the tools they need to make an impact on patients’ lives.

As Posa said: “These changes will more effectively alert providers to the presence of sepsis, enabling them to begin treatment earlier and ultimately improve outcomes for patients.”