Kaiser Permanente's Redesigned Treatment Detects Sepsis Risk Earlier and More Often

Evidence-based care process outlined in an article in The Joint Commission Journal on Quality and Patient Safety

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Oct 19, 2011, 01:00 ET

OAKLAND, Calif., Oct. 19, 2011 /PRNewswire/ -- Redesigned processes of care and evidence-based treatment algorithms led to earlier detection of patients at risk for sepsis, according to an article published in the November 2011 issue of The Joint Commission Journal on Quality and Patient Safety. The article, titled "Collaborative Improvement in Sepsis Identification and Treatment — Kaiser Permanente's Performance Improvement System, Part 3: Multisite Improvements in Care for Patients with Sepsis," describes Kaiser Permanente's initiative for early detection and expedited implementation of sepsis treatment bundles that included early goal-detected therapy (EGDT).

This is the third article in a series that chronicles Kaiser Permanente's journey toward developing an enhanced Performance Improvement system that has contributed to continued improvement across the health care organization on all key quality metrics.

Sepsis is a very severe infection that is spread via the bloodstream. The U.S. Department of Health and Human Services recently identified sepsis as the No. 1 cause of death in U.S. hospitals, afflicting an estimated 750,000 people and resulting in 117,000 to 215,000 deaths. The majority of sepsis cases are patients who present to hospitals with sepsis and did not acquire the condition as inpatients. Sepsis is the most frequent cause of hospital mortality.

The initiative to improve sepsis care by identifying and stratifying the risk of patients suspected with sepsis was implemented by Kaiser Permanente Northern California in 2008. In a top-down, bottom-up approach to performance improvement, teams at 21 medical centers decided how to implement treatment bundles, using a "playbook" developed by rapid-cycle pilot testing at two sites and endorsed by a sepsis steering committee of regional and medical center clinical leaders. The playbook contained treatment algorithms, standardized order sets and flow charts, best practice alerts, and chart abstraction tools.

The authors conclude, "The top-down, bottom-up approach of the sepsis performance improvement initiative was pivotal. Regional operational and clinical leaders identified the goal and provided support, and frontline teams implemented evidence-based care in ways that were sensitive to variations between settings."

After implementation of the early detection processes and the treatment bundles, the results were dramatic. The number of sepsis diagnoses per 1,000 admissions increased from a baseline value of 35.7 in July 2009 to 119.4 in May 2011. The percent of admitted patients who were appropriately tested for sepsis increased from a baseline of 27 percent to 97 percent in May 2011. The percent of patients receiving EGDT, or early goal-directed therapy, who showed improvement on key lab values within six hours increased from 52 percent at baseline to 92 percent in May 2011.

"This is perhaps one of the best examples of the impact a large organization can have when focusing on the quality of care," said Lisa Schilling, RN, vice president of national performance improvement in Kaiser Permanente. "When an organization develops improvement capability and aligns leadership attention to strategically important efforts, the result is reliable delivery of care to an entire population."

The final article in the four-part series will present what was discovered about becoming a learning organization in quality, and how an organization can leverage the power of people and systems to more rapidly share and adapt practices to continually transform the way the business of health care is conducted. The article will be published in the December 2011 issue of The Joint Commission Journal on Quality and Patient Safety.

The authors of "Collaborative Improvement in Sepsis Identification and Treatment — Kaiser Permanente's Performance Improvement System, Part 3: Multisite Improvements in Care for Patients with Sepsis" are as follows: Alan Whippy, MD; Melinda Skeath, RN, CNS; Barbara Crawford, RN, MS; Carmen Adams, DNSc, RNC; Gregory Marelich, MD; Mezhgan Alamshahi, MBA; Josefina Borbon, MD.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.8 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.

http://www.kaiserpermanente.org

For more information:
Mark Camps, [email protected], 510-625-5624

SOURCE Kaiser Permanente