Sepsis, a life-threatening emergency, happens when an infection you already have triggers a chain reaction throughout your body. One of every three patients who dies in the hospital has sepsis. The life-threatening response to infection is difficult to detect in its earliest stages, and every hour the condition goes untreated increases a patient’s mortality risk by 4%.
The University of Missouri Health System consists of five hospitals with 602 beds in total. After implementing Cerner’s Sepsis Management solution in February 2017, teams at the University of Missouri Health Care and the Tiger Institute focused on turning early detection into prompt action. Their work helped increase proactive intervention from the organization’s rapid response team (RRT) — the Tiger Team — while reducing sepsis mortality rates and decreasing code blue calls to resuscitate patients, reports MU Health Care.
The teams configured Cerner solutions to automatically calculate each patient’s national early warning score (NEWS) and help care teams follow MU Health Care’s NEWS-driven nursing protocol. NEWS summarizes a patient’s risk for clinical decline based on commonly tracked vital signs. The higher the NEWS, the more serious the patient’s condition.
“A patient’s NEWS helps aggregate small changes that, on their own, might seem harmless,” explained the project’s physician champion, Catherine Jones, MD, hospitalist and medical director for medical specialties. “The scores help us catch sepsis early, when it’s difficult to spot but easier to treat, and trigger prompt action.”
The researchers at MU Health Care analyzed historical patients’ scores to identify when patients typically require RRT intervention or transfer to the intensive care unit (ICU). Guided by those thresholds, they developed an algorithm and a NEWS-driven nursing protocol to help caregivers act appropriately based on the patient’s status and location within the hospital.
“Once we identified critical NEWS thresholds, we could establish a preemptive protocol,” said Jones. “We try to stay a step ahead of the infection.”
Since MU Health Care turned on NEWS alerts at University Hospital in August 2019, rapid response calls increased 63% and code blue calls decreased 40%.
“Reaching patients with the rapid response team sooner helps avoid code blue calls,” said Mason Crawford, MHA, RN, performance improvement coordinator. “We’re avoiding patient decline.”
By comparing actual sepsis mortality to projections based on pre-implementation mortality rates, MU Health Care estimates NEWS and NEWS-driven nursing protocol helped avoid 12 sepsis-related deaths in nine months. University Hospital’s mortality index — a ratio of observed deaths to expected deaths, given the severity of septic patients’ primary diagnoses and comorbidities — dropped 22% during that time.
“We knew the project would impact our sepsis mortality rates, but we didn’t realize how significant it would be,” said Benjamin Wax, BSN, RN, senior clinical informaticist at MU’s Tiger Institute.