Sepsis Showdown: A Unified, Interregional Approach to Sepsis Diagnosis and Treatment

Abstracts from the Kaiser Permanente2018 National Quality Conference


Cara Steinkeler, MD; Kenneth Robinson, MD

From Colorado, Georgia, Hawaii, Northern California, Northwest, Southern California, Program Offices

Background: Sepsis-related diagnoses (SEP) are life-threatening conditions caused by a dysregulated host response to infection or inflammation. Progression from signs of an inflammatory response to severe sepsis and septic shock requires prompt recognition and treatment to achieve the best clinical outcomes. Kaiser Permanente (KP) has been on a sustained journey to improve the care of patients with sepsis, with a goal of minimizing sepsis-related deaths and injury. In the past year, an interregional group has worked on additional resources, tools, and data to support these efforts.
Methods: In 2008, KP developed a performance-improvement program to screen and provide effective treatments to patients identified as at-risk for sepsis. The program included education of sepsis champions, quality improvement staff, and operational leadership; development of sepsis scorecards with performance metrics; and ongoing sharing of quality improvement strategies and novel sepsis-related initiatives. Clinical strategies for evaluating and treating patients with less severe sepsis have continued. In 2017 an interregional Sepsis Workgroup was chartered by the KP National Quality Committee. Landscape analysis, definitions and guidelines, and analytics subgroups have completed work which will be shared during this session.
Results: During the past 6 years, increased awareness about sepsis has led to better identification of patients, resulting in an increased number of cases coded as having sepsis, severe sepsis, and septic shock. Mortality among patients admitted to Kaiser Foundation Hospitals with sepsis decreased from 12.0% to 8.1%, and for those patients with severe sepsis and septic shock, mortality over this same 6-year period has decreased from 20.2% to 13.1%. However, in Kaiser Foundation Hospitals, performance on SEP-1 (the bundle of sepsis and severe sepsis/septic shock process measures) varies from 46% to 86%. Although KP outcomes such as inpatient mortality for patients with sepsis-related conditions are lower than those reported in the literature, there are opportunities to improve performance on sepsis bundles/process measures.
Discussion: Chart audits for the Centers for Medicare and Medicaid Services core measures for sepsis may not reflect performance, and thus the focus of this work has been on mortality. However, standardization of metrics across Regions and an automated means of obtaining data will provide better information on performance. Members of the interregional Sepsis Workgroup will share leading practices from across KP for early identification and risk stratification of patients with sepsis. Decision-support and documentation tools will be shared as will educational resources. A status update will be provided on analytic work in progress to improve automated abstraction of sepsis processes and outcome measures.

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