Latest / Becker’s Healthcare Podcast / Dr. Chris Thomas, Vice President and Chief Quality Officer at FMOL Health

Transcript

Dr. Chris Thomas, Vice President and Chief Quality Officer at FMOL Health · Becker’s Healthcare Podcast

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  - Hi. My name is Paige Twinter, and I'm
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  - an editor with Becker's Healthcare. Thank you all
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  - so much for joining the Becker's Healthcare podcast.
• 0:58
  - I'm joined today by doctor Chris Thomas, vice
• 1:01
  - president and chief quality officer
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  - at a Louisiana system. Doctor Thomas, can you
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  - please introduce yourself,
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  - and tell us a bit about your organization
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  - and your role?
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  - Yeah. Hey. Thank you so much for having
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  - me.
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  - I am a trained,
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  - and still practicing critical care physician at FMLA
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  - Health,
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  - which is a 10 hospital system, in Louisiana
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  - and Mississippi where we get to take care
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  - of,
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  - communities ranging anywhere from Jackson to Bogalusa, Louisiana
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  - with a flagship location
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  - in Baton Rouge, Louisiana,
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  - referred to as our Lady Lake.
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  - I get the opportunity to lead,
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  - a team of extremely talented quality and performance
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  - improvement experts at
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  - at FOMO, and then specifically, my job is
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  - to design and implement strategies that improve outcomes
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  - in every patient,
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  - along our patient centered clinical themes. So we
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  - have focuses at FMO that include mobility, which
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  - is our way of preventing hospital acquired disability.
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  - We ensure bloodstream sterility, which is, again, our
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  - themed approach to hospital acquired infection.
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  - We're really passionate about social determinants of health,
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  - and so my job revolves around trying to
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  - make sure we can connect those to patient
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  - outcomes. And then finally, in in... For this
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  - conversation,
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  - the, identification of of time sensitive diseases ranging
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  - anywhere from opioid use disorder
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  - to our topic today, sepsis.
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  - And FML health, I am impressed by how
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  - easily you can get that rolled off the
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  - tongue. I had to practice a bunch of
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  - times. But,
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  - with sepsis, I know your organization has,
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  - like,
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  - had incredible
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  - results.
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  - What gap in care did your team
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  - see?
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  - Wow. That's a great question.
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  - Our team really, after the pandemic, saw a
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  - lack of innovation
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  - really compared to the two other major time
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  - sensitive illnesses, stroke and heart attack.
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  - We had gone through evolutions in care where
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  - we utilized the CT scan and endovascular clot
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  - retrieval for stroke. We obviously moved door to
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  - balloon,
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  - and cardiac,
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  - diseases, including and specifically acute myocardial infarction, and
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  - then we advanced even to things like ECMO
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  - and mechanical circulatory support.
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  - And and here we were,
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  - in 2023
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  - going on... In sepsis, we were using a
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  - diagnosis that had been developed in 1992
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  - through a consensus statement, which was a collection
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  - of vitals and a laboratory result.
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  - So the gap for us was a need
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  - for better diagnostics,
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  - and, honestly, better accuracy and driven by,
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  - our frontline
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  - team, our providers and our nurses who said,
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  - stop for a second. We're supposed to be
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  - good at performance improvement.
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  - Let's think about this differently. Is there a
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  - better way to do this than what we're
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  - currently doing in every day, which I think
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  - is about courage?
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  - You said it's about courage? Yeah. I think
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  - the courage part is about,
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  - if you take something that you do every
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  - day, but you feel like you do it
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  - well and you're willing to change, that's the
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  - first. And then the other is it was
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  - a little bit easier as you mentioned,
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  - or we talk about workflows.
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  - We modeled after chest pain and stroke, so
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  - the workflows weren't critically different. But the need
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  - for feedback to the team,
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  - after using new technologies, and in our case,
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  - a host response technology,
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  - was the unique and critical aspect. And so
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  - there's curiosity and there's courage in that where
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  - you say, we have really, really good outcomes.
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  - We wanna get to elite.
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  - And then you start thinking about,
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  - let's be curious. And curious is I'm gonna
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  - put a new technology in, and I'm gonna
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  - give feedback to learn in real time and
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  - scale with the teams. And so I think
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  - those are two critically important features when you're
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  - thinking about new innovations.
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  - You mentioned the unique and critical aspect of
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  - the need for feedback.
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  - What
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  - feedback was most surprising to you, would you
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  - say?
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  - I think the first feedback was we have
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  - a tremendous amount physicians who were confident that
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  - they could recognize
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  - the disease.
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  - After we began to use host response technology,
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  - it was clear to many of us, including
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  - myself, who is a practicing intensivist,
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  - that what we thought was the disease,
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  - had opportunity for us to recognize the patients
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  - did not have it. So we were really
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  - biased into the idea of having
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  - a 100 patients who would come in. They
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  - would have a certain set of vitals, and
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  - we would put that diagnosis, let's say, on
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  - the whole group. And then after about three
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  - months, we recognized despite really good
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  - screening
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  - and then what we thought was being more
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  - specific to say the patients had sepsis, about
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  - fifty percent of those people had a different
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  - disease. And that's important
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  - because diagnostic accuracy in every disease
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  - has always been critical.
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  - Treatment
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  - that in time sensitive means you have to
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  - get it right quickly, but there's no disease
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  - we ever said, well, we're gonna favor one
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  - diagnostic accuracy
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  - over another.
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  - And so we'll go down this train, and
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  - then we'll keep going until we realize it's
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  - absolutely not it and then pivot to what
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  - the patient actually has. And so I think
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  - it's just a a really big
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  - change in the thought process and that feedback
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  - of, oh, wait. What I thought I was
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  - seeing now that I have objective
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  - patient centered data on their biology is actually
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  - something different.
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  - Some of the
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  - kind of results that so far I've seen,
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  - have just been really kind of, like,
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  - crazy spectacular.
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  - Since June, I saw... And correct me if
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  - these numbers are,
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  - wrong. But mortality among sepsis patients,
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  - is down twenty four percent
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  - at FMOL Health.
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  - And antibiotic
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  - use is down fourteen
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  - percent. Are those numbers still correct?
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  - They are.
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  - What... Can you kinda...
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  - That's kinda more like
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  - quantitative. Can you describe in, like, a qualitative
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  - way what
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  - those percentages mean?
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  - Yeah.
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  - So
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  - I think the the key
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  - thread there is that
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  - diagnostic accuracy creates patient centered outcomes. But let's
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  - think about it from a family perspective. That
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  - means for us at m f o... FMO
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  - Health, we're saving a life one every three
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  - days.
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  - And so that means every three days compared
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  - to the approach we had before, which again
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  - was good in the standard of care,
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  - we're dramatically improving lives.
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  - On the other side of that, I think
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  - we talk about
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  - what do those
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  - qualitative things are, versus quantitative. And I think
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  - the qualitative thing for us is do we
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  - get people back to their dinner tables?
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  - Do they
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  - get to go home
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  - earlier and go and have a conversation with
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  - those that they love? There are many of
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  - our patients who are
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  - responsible
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  - for key units,
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  - of their family, and being in the hospital
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  - is a major disruption. So when we talk
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  - about mortality and we talk about the lack
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  - of exposure antibiotics, really what it comes down
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  - to is the lives saved and the 30,000
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  - dinner table conversations that we've created over two
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  - years that families are able to have that
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  - they didn't before.
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  - Are those 30,000 over two years, is that
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  - different from the... Or is that the same
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  - as saving about 30,000
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  - hospital days? It is. So when you talk
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  - about those two, we,
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  - that length of stay feels very,
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  - non patient centered in the conversation. Right? We
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  - as health care personnel,
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  - talk about length of stay reduction. We talk
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  - about things like reduction in antibiotic exposure.
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  - But when you go to an ER and
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  - you get to your frontline nurse and you
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  - go, this patient comes in, what are the
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  - things that matter to them?
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  - The patients really don't
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  - don't care if their diagnosis is heart attack.
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  - They don't care if it's sepsis. They don't
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  - care if it's something different. They want us
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  - to get it right, and they wanna go
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  - home. And so those patient centered things, I
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  - think, are the critical answers of, we're gonna
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  - talk about length to stay, but when we
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  - talk to the patients, we're gonna say our
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  - job is to get you home and have
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  - that conversation.
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  - How has that
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  - affected
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  - ED throughput and capacity?
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  - Oh, that that is the the key feature,
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  - I think, to the utilization of host response
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  - technology
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  - at the current
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  - at the current pace.
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  - First,
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  - we all have the
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  - fortune,
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  - when you're in big medical centers of getting
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  - to take care of patients. That also means
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  - in rural communities, there are patients that need
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  - to get to us.
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  - Throughput is really critical. So if I can
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  - make a diagnosis
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  - quicker,
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  - then I can get the treatment started earlier.
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  - And sepsis is one of the diseases where
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  - antibiotic delivery and early recognition has been proven
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  - to give better outcomes, the same ones you
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  - just referenced. But more importantly,
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  - in tests that, allow us to say they
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  - do or do not have sepsis, it allows
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  - us to safely discharge patients as well.
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  - So if you look at that element, then
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  - you have an ER where we're hoping to
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  - take people from rural communities and land them
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  - and take care of them. And we have
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  - the... Our local community that also is coming
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  - to our emergency department. You have to be
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  - really efficient. So a safe discharge,
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  - which we're up by 15%, means the patient
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  - goes home and doesn't come back within three
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  - days. We track that. That's a patient centered
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  - outcome, allows us to have another bed available.
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  - That length of stay you talked about
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  - creates
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  - another bed on the floor that if a
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  - person needs to be admitted, they move up.
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  - And then the blood culture stuff, we're down
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  - about thirty percent in blood cultures. I think
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  - that one is underrepresented
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  - because what that means is that we're giving
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  - back time and working up people in the
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  - emergency department, which can be afforded to others.
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  - Go find someone else who's sick. So that
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  - throughput
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  - is really been impacted by the idea of
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  - being able to be diagnostically
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  - accurate
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  - and being rapid with it.
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  - Particularly, if you can get a turnaround of
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  - an eight to ten minutes, then all of
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  - a sudden, you... You're at a markedly better
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  - spot to be able to move your patients
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  - through the continuum of care, whether that's making
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  - them get a CAT scan, whether it's just
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  - thinking about how you get discharge disposition in
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  - that follow-up appointment.
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  - That,
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  - 15%
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  - increase
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  - in safe dish... Safe discharges or, you know,
• 11:38
  - discharges,
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  - don't result in a readmission within three days.
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  - And then
• 11:43
  - the 30% decrease in blood cultures, is that
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  - also since June, or what what time frame
• 11:48
  - is that? Yeah. So our journey, if you
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  - think about it from a whole health system,
• 11:53
  - started with a pilot, I would... With a
• 11:55
  - launch,
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  - in 2023
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  - to flagship in Baton Rouge. That was our
• 12:00
  - lay of the lake. And then we did
• 12:01
  - a step wedge design
• 12:04
  - over the next
• 12:05
  - two years starting right around April 2024 with
• 12:08
  - our four other acute care hospitals,
• 12:11
  - and we did them. We launched two in
• 12:12
  - one month, and then followed the next month.
• 12:15
  - And so the results that I'm telling you,
• 12:18
  - are ones that we've been able to present
• 12:20
  - nationally
• 12:21
  - are about the idea of what's happened to
• 12:23
  - the health system
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  - consistently
• 12:26
  - over that period of time since 2023.
• 12:29
  - When you get our global numbers now that
• 12:31
  - are always changing because we're evaluating sepsis patients
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  - every day, as of today,
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  - we've been able to test and evaluate over
• 12:39
  - 80,000 patients and maintain those percent reductions over
• 12:43
  - that period of time throughout all of our
• 12:46
  - hospital. The most remarkable part was you're talking
• 12:49
  - about an academic hospital, a community hospital,
• 12:52
  - a large kinda safety net hospital in Monroe,
• 12:55
  - Louisiana,
• 12:56
  - and then,
• 12:58
  - another large specialized complex medical center in Jackson.
• 13:01
  - And each one of them has the same
• 13:03
  - trends, reduction in antibiotic exposure, improvement in blood
• 13:08
  - culture resource utilization, mortality reduction in the sepsis
• 13:11
  - patients, mortality reduction in the patients proven not
• 13:14
  - to have sepsis, and then what I refer
• 13:17
  - to as increasing the dinner table conversations.
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  - Yeah. I know whenever,
• 13:23
  - you... And you mentioned this too of kinda
• 13:25
  - like healthcare leaders, you know, rattling off length
• 13:29
  - of stay reductions,
• 13:31
  - percentage of reduction in antibiotic use, or even,
• 13:34
  - you know, the beloved,
• 13:36
  - acronyms like
• 13:38
  - CMI and others. Like, it's just like, okay,
• 13:41
  - like, what does that... What does that mean
• 13:43
  - for the patient? I really liked your example
• 13:45
  - of, you know, getting these patients back to
• 13:48
  - the dinner table. Then also that frees up,
• 13:51
  - more capacity, more space for the patients coming
• 13:54
  - in,
• 13:55
  - to get them seen and cared for sooner.
• 13:59
  - For...
• 14:00
  - We only have about a minute or two
• 14:02
  - left.
• 14:03
  - My last question is what advice would you
• 14:05
  - give,
• 14:07
  - you know, other chief quality officers at other
• 14:09
  - health systems
• 14:11
  - looking to kinda replicate your work?
• 14:14
  - Yeah. I I I take away good conversations
• 14:16
  - that I steal from others. And so I
• 14:18
  - think we have to believe in consistency, meaning
• 14:21
  - we have to reduce variability.
• 14:23
  - Using host response technology does that for us
• 14:26
  - in sepsis. It's no longer a question
• 14:28
  - about the history that you can take. It
• 14:30
  - is the history plus an objective biologic marker.
• 14:33
  - The next is to engage in curiosity and
• 14:35
  - be willing to innovate.
• 14:37
  - Our surgery colleagues have done this for years,
• 14:39
  - and the medicine world has been a little
• 14:41
  - bit slow. Right? If you think about surgery,
• 14:43
  - we do deep brain stimulation now that we
• 14:45
  - never thought we could do before. We do
• 14:47
  - robotic surgeries in areas we don't. We have
• 14:50
  - ECMO and then even ECMO in the ED
• 14:52
  - in The United States, but somehow,
• 14:54
  - we
• 14:55
  - weren't willing at some point to innovate in
• 14:58
  - other areas. So those are the three things.
• 15:01
  - And and then I would say, don't be
• 15:02
  - afraid
• 15:04
  - to do something that's novel. But if you're
• 15:06
  - gonna do something that's novel, study it and
• 15:08
  - then,
• 15:09
  - and then share it. And then the last
• 15:10
  - part, I'll just say, is also question
• 15:13
  - things that you've been told or things that
• 15:15
  - are in your health system where someone tells
• 15:17
  - you this is,
• 15:19
  - an absolute.
• 15:20
  - I think we have to be intellectually curious
• 15:23
  - as we continue to innovate about, is that
• 15:25
  - true,
• 15:26
  - or can I think about it differently? And
• 15:28
  - that requires rooms
• 15:30
  - with,
• 15:31
  - putting the patient in the center and every
• 15:33
  - potential discipline
• 15:34
  - that takes care of that patient to be
• 15:36
  - in the same room when you start modeling
• 15:38
  - out these innovations, that's really critical. So in
• 15:41
  - our meetings in FMO health from a quality
• 15:43
  - perspective, we never have one discipline. In fact,
• 15:45
  - we won't have meetings unless we have three,
• 15:48
  - at the big project ones from stakeholder perspective.
• 15:51
  - And so that's my advice. If you're in
• 15:52
  - a room with one discipline or two discipline,
• 15:55
  - I just think, is it possible for the
• 15:57
  - topic you're talking about for the patient to
• 16:00
  - only see those two disciplines during a hospital
• 16:03
  - stay? If the answer is
• 16:04
  - no, stop the meeting, go figure out who
• 16:07
  - would see the patient, and restart it again.
• 16:11
  - That obviously represents the more multidisciplinary,
• 16:15
  - like,
• 16:16
  - comprehensive care that patients are increasingly receiving. So
• 16:20
  - Absolutely.
• 16:21
  - Yeah. Yeah. That's, unfortunately, all the time we
• 16:23
  - have today for,
• 16:25
  - our podcast. But thank you so much, doctor
• 16:27
  - Thomas, for joining us today. Thank you so
• 16:29
  - much for having me, and, hope you have
• 16:31
  - a great day.