President, Clinical Services and Chief Medical Officer, Nashville, Tennessee-based HCA (Hospital Corporation of America). “The Honorable Jonathan B. Perlin” was Under Secretary for Health in the U.S. Department of Veterans Affairs, led the nation’s largest integrated health system.
Category of Humanitarian Benefit: Health and Medical
One of the nation’s leading providers of healthcare services, HCA is made up of locally managed facilities that include 185 hospitals and 119 freestanding surgery centers located in 21 U.S. states and in the United Kingdom.
28+ million patient encounters each year.
8.6 million emergency room visits annually
HCA hospitals are on The Joint Commission’s list of Top Performers on Key Quality Measures
HCA named one of the World’s most ethical companies for nine years in a row
Project Name and Description
To develop SPOT, which stands for Sepsis Prediction and Optimization of Therapy, clinical staff scoured 10 years of HCA patient encounter data for known cases of sepsis and then identified common characteristics associated with the condition. Those characteristics were then embedded into SPOT as the criteria used to detect sepsis in every patient.
“We wanted to build a smoke detector to sniff out the earliest signs of sepsis,” Perlin said.
Performance data so far shows that from 2017 to 2018, SPOT has helped reduce sepsis mortality by an additional 23% at HCA, Perlin said.
SPOT works by evaluating every new piece of information that is added into the patient’s health record during an inpatient stay including their vital signs, lab results and nursing reports. This is something staff can’t do.
“You want your clinician to be not only at the bedside but also at the computer looking at every new piece of data, every new blood culture and you want them to act on it the moment it was created,” Perlin said. “But clinicians can’t be both at the bedside and at the computer.”
SPOT generates an alert in the EHR if a patient meets the criteria for sepsis. Who gets the alert depends on the hospital. At small HCA hospitals, physicians and bedside nurses will receive the alert. At TriStar Centennial Medical Center, a 744-bed facility, a rapid-response team staffed with experienced intensive-care unit nurses gets the alert. The hospital’s reported rate of 4.15 cases of post-operative sepsis per 1,000 elective surgical discharges in 2017, according to Modern Healthcare Metrics, put it below the benchmark 5.37 rate for hospitals with 500-plus beds.
One person is at a computer 24/7 to respond. When an alert comes in, the nurse checks the data to confirm sepsis treatment is needed.
If the nurse agrees sepsis treatment is required, he or she quickly lets the patient-care team know. That includes the on-call physician. TriStar Centennial has a secure messaging system that allows staff to easily text or call one another.
Dr. Michael Nottidge, an ICU physician and critical care medical director at TriStar Centennial, said the setup works well because the rapid-response team rounds daily and they are familiar faces to most of the clinical staff.
In cases where the alert shows the patient is showing early warning signs of sepsis, the nurse will initiate the first steps of the Surviving Sepsis Campaign bundle, including obtaining blood cultures and ordering antibiotics. With alerts that show more serious signs of sepsis, the nurse will usually send another member out to attend to the patient immediately while alerting other clinical staff.
With more than 258,000 lives being lost per year, sepsis ranks as the third leading cause of death in the U.S. (after heart disease and cancer). Using data by the Centers for Disease Control and Prevention (CDC), sepsis would rank higher than chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, and accidental deaths. The same H-CUP report identified that there are more than 1.6 million cases of sepsis every year and survivors often face long-term effects post-sepsis, including amputations, anxiety, memory loss, chronic pain and fatigue, and more. Almost 60% of sepsis survivors experience worsened cognitive (mental) and/or physical function.
Sepsis has been named as the most expensive in-patient cost in American hospitals. One report stated the the costs were $24 billion in 2014. But at an average of over $18,000 per hospital stay and with over 1.5 million sepsis hospital stays per year, this actually works out to costs of $27 billion each year.
Studies investigating survival have reported slightly different numbers, but it appears that on average, approximately 30% of patients diagnosed with severe sepsis do not survive. Up to 50% of survivors suffer from post-sepsis syndrome. Until a cure for sepsis is found, early detection and treatment is essential for survival and limiting disability for survivors.
Since our introduction of SPOT technology in 2018, it has been used to monitor more than 2.5 million patients across 164 hospitals. It is our most powerful tool in the battle against sepsis, and along with evidence-based clinical interventions, has helped us save an estimated 8,000 lives over the last five years.