Septicemia continues to pose a challenge to hospitals: A statistical brief¹ released recently by the Agency for Healthcare Research and Quality indicates not only that 47.1% of aggregate hospital costs incurred in 2011 were related to the 20 most expensive conditions to treat, but that the top five such conditions, septicemia among them, accounted for nearly a fifth (18.5%) of the total aggregate costs of all hospitalizations. Perhaps it’s even more significant that the brief identifies septicemia as the most expensive condition treated in hospitals in fiscal 2011, with an aggregate cost of $20.3 billion (or 5.2% of the total aggregate cost for all hospitalizations) required to cover its remediation. The National Institute of General Medical Sciences estimates the incidence of severe sepsis cases in the United States at approximately 750,000 per year.² A total of 28% to 50% of these individuals die³ this mortality rate far exceeds those for prostate cancer, breast cancer, and AIDS—combined. As consolidations and merger initiatives create even larger, more geographically diverse entities, health-care systems are particularly challenged to deliver a consistent level of care. Trinity Health, which merged with Catholic Health East in May 2013 to form CHE Trinity Health (Lansing, Michigan), addressed this challenge head-on two years ago, when it undertook an enterprisewide initiative aimed at addressing and controlling septicemia better. Known as the Sepsis Collaborative, the initiative yielded a savings of nearly $17 million and has significantly reduced septicemia mortality rates. As a result, its elements are being implemented across all Catholic Health East hospitals in the CHE Trinity Health network, which now serves patients and communities in 21 states (through 82 hospitals, 89 continuing-care facilities, and numerous home and hospice programs). Prognosis: Improvement Needed Prior to its consolidation with Catholic Health East, Trinity Health was the 10th-largest health system and the fourth-largest Catholic health system in the country, by total number of acute-care hospitals (49) and by bed count, respectively. In 2010, a decision was made to adopt the Accenture clinician-led unified clinical organization (UCO) model as a means of delivering the highest-quality, safest, most efficient care for every patient—every time and in every location, according to Paul Conlon, PharmD, JD, vice president, clinical quality and patient safety. Under the UCO umbrella, collaboratives are identified and prioritized with cooperation and input from a broad base of representatives from each of the hospital’s systems ministries, including financial, administrative, and community-benefits leaders; clinician leaders; frontline physicians; nursing-council members, pharmacy-council members; CMOs; and IT personnel. Septicemia was one of the first collaborative efforts undertaken in line with the UCO model—in part, because of the expenditures associated with treating it. A desire to do better also spurred Trinity Health to address it through a Septicemia Collaborative. “Our mortality rate was lower than the national average, but we knew we could do better with standardized care,” Conlon reports. Expert clinicians from throughout the system, as well as representatives from IT (many of them clinicians themselves) identified the evidence-based practices that could best support appropriate clinical process flows, and with IT at the table, these flows were enhanced with system modifications. For example, new rules were created to assist clinicians in the early identification of sepsis and septic shock and to provide them with suggestions for evidence-based interventions that can prevent further progression of these conditions. In addition, summary views of completed interventions for a given patient were constructed to afford clinicians continued direction. “The system is set up to support clinicians fully at the point of care, in terms of everything from suggesting that sepsis may be present (based on particular warning signs) to asking them whether they want to initiate treatment to laying out a power plan to address treatment to tracking lactate levels to ensuring proper fluid and antibiotic management,” Conlon observes. Location-specific adjustments accommodate such variables as the predominance of different pathogens in particular regions of the country. Conlon adds that the key here is a wealth of actionable, consistent information, citing tools in the electronic medical record that support clinicians in their care of patients every day. “The sepsis work has not necessarily changed the way clinicians interact with the health-care record, but it has certainly changed the way clinicians address sepsis, making it much more likely that it will be detected early, that evidence-based practices will be employed, and—as a result—that lives will be saved,” he says. Lives and Money Saved Conlon says that CHE Trinity Health is pleased with the results produced by the Sepsis Collaborative to date. In fiscal 2011, the only year for which results (applicable solely to the original 49-hospital Trinity Health system) are yet available, Trinity Health achieved an 18% reduction in mortality rates for patients with severe sepsis and septic shock. The overall mortality rate for sepsis patients decreased from 15.8% in fiscal 2010 to a current rate of 13%. A total of 406 sepsis patients survived the condition during the 12-month postimplementation period; Conlon anticipates that this number will increase, going forward. Moreover, the initiative wrought a $16.6 million reduction in direct variable costs, compared with the baseline year of fiscal 2010, as well as a one-day reduction in patients’ average lengths of stay. “The saving on sepsis proves that if it is identified and treated earlier, the intensity of care (and in turn, cost) is reduced,” Conlon says. “Fewer patients end up in the ICU. Just as important, increased awareness and earlier treatment lead to better care, but all of this is only possible with a collaborative effort that involves constituents from all ministries and departments from the very beginning. This will remain so as we move ahead with other collaboratives—so far, there have been about 14—and incorporate the CHE side.” Results of other collaboratives executed under the UCO have been equally positive. For example, streamlined medication-reconciliation processes yielded a 20% improvement in composite medication reconciliation, a 62% improvement in medication reconciliation completion for admitted patients, and a 5% reduction in adverse drug events. “Collaboration has had a huge effect,” Conlon concludes. “Sepsis is just one example—but a very important one.” Julie Ritzer Ross is a contributing writer for HealthCXO.com.

References

1. Pfuntner A, Wier LM, Stocks C. Statistical brief #162: most frequent conditions in U.S. hospitals, 2011. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.pdf. Published September 2013. Accessed November 5, 2013.
2. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-1310.
3. Wood KA, Angus DC. Pharmacoeconomic implications of new therapies in sepsis. PharmacoEconomics. 2004;22(14):895-906.