Latest / Becker’s Healthcare - Clinical Leadership Podcast / The Future of Sepsis Care: Building Systems That Support Patients and Clinicians

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The Future of Sepsis Care: Building Systems That Support Patients and Clinicians · Becker’s Healthcare - Clinical Leadership Podcast

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  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning into the
• 0:04
  Becker's Healthcare podcast series. Today's episode is brought
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  to you by Zebra Technologies and Ambien Clinical
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  Analytics.
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  Today, we're going to talk about the future
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  of sepsis care, building systems that support patients
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  and clinicians. And joining me for today's discussion
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  is Mary Grace Cox, senior director of clinical
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  programs at UAB Medicine.
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  Mary Grace, thanks so much for being here
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  today. It's great to have you.
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  Yes. Thanks for having me.
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  Absolutely. I wanna start off with introductions for
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  our audience. If you could just kick us
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  off, share a little bit about yourself, and
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  your work in health care. Yeah. Absolutely.
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  So I'm a nurse, by training and have
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  been at UAB Medicine for a little over
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  fourteen years.
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  I started at the bedside caring for oncology
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  patients, and then in 2016,
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  I moved into the quality space as our
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  sepsis coordinator.
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  And that's where I really saw how much
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  we can impact patients by improving systems, not
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  even just at the individual patient level, but,
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  really for systems and then supporting those clinicians
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  that deliver care.
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  And so now I focus on clinical effectiveness
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  programs with sepsis being one of the biggest.
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  And my role is all about really partnering
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  with teams to improve outcomes and making their,
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  their day to day work a little bit
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  easier too.
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  I was going to say, I feel like,
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  again, we talk about sepsis quite a bit.
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  It it it is one of the most
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  pressing challenges in acute care. As you've mentioned,
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  it's it's a big part of the conversation
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  for everybody.
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  From your perspective,
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  what have we learned in recent years about
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  improving patient outcomes in that space, and and
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  what factors are most critical for moving the
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  needles when we specifically look at mortality rates?
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  Yeah. It's a great question because mortality is
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  something that is so challenging to move the
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  dial on.
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  And for sepsis, it's tricky too because the
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  science really hasn't changed that much. You know,
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  it's early detection, early treatment,
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  the things that we really know. And especially
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  our clinicians, they know how to treat sepsis.
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  But the real sort of progress
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  comes,
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  from when we pull together people, so our
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  clinicians, our experts in the field,
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  and give them good process and technology to
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  support that. My colleague, Tim, from Ambient,
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  really kind of honed in on that recently.
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  And so clinicians bring that expertise.
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  The process gives that consistency, and then the
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  technology,
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  like the Ambient Dart tool sort of ties
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  it all together.
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  And Dart helps us spot trends and variations
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  really quickly so we can sort of adjust
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  in real time, and that combination
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  is really what's helped us drive down mortality
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  in a meaningful way. And so I think,
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  you know, if you've worked in the sepsis
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  space for a long time, you know that
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  there's no smoking gun. There's no one thing
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  that says, like, oh, this is gonna fix
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  our sepsis problem at whatever organization you're at.
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  It's really about designing really good processes and
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  systems that support clinicians, and so that's kind
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  of what DART helps us to do. And
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  DART, by the way, stands for the detection
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  and response tool for sepsis.
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  And so another kind of thing that DART
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  has allowed us to do is, I think,
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  kind of driven towards a cultural shift for
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  us. Mhmm. We used
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  to sort of have to continually campaign
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  our, clinicians,
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  and really go around and raise awareness and
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  do all these kind of things for, you
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  know, education.
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  And we were educating people who already knew
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  how to care for their patients with sepsis,
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  and so it really wasn't that effective.
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  And so we're able to sort of stop
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  continually campaigning
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  and drive us more toward that culture of
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  continuous readiness,
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  where sepsis is not something the clinician has
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  to be reminded about. It's just sort of
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  embedded into their daily practice.
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  And I I once I'm reminded of something
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  a colleague once said at a conference that
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  said, sepsis will highlight everything that's wrong with
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  your organization, which sounds pretty discouraging,
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  kind of at face value. But it really
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  stuck with me, because it's, you know, it's
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  true because it touches so many patients across
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  the hospital that you work in. You end
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  up uncovering,
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  you know, opportunities that are not just tied
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  to sepsis itself, but go
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  almost like a magnifying glass. You kind of
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  see gaps in communication and workflow and breakdowns
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  in care coordination. And when you address those
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  based on what you see with sepsis patients,
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  you kind of benefit the entire organization
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  at the same time. Yeah. And I'm so
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  glad that we have you on because, again,
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  you bring such a such an important perspective
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  to this from the nurses' side. Right? From
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  from the clinician's perspective to this conversation.
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  And you've touched on the technology piece and
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  the change management part of it too in
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  terms of having those conversations with nurses about
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  technology and how it impacts their day and
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  how it does influence
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  the day to day experience as well. I
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  was wondering if you could elaborate a little
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  bit on sort of that that clinical innovation
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  piece and how it's influenced clinicians,
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  but then also what lessons that stand out
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  to you from this process when it comes
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  to supporting them effectively through technology?
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  Yeah. Absolutely. So, I would say
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  based on experience
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  working clinically and then also based, you know,
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  on my experience in the quality space, the
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  best kind of technology solution is the kind
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  that you do not notice at all. It
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  just makes your job smoother. It just runs
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  in the background,
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  and you don't really know what's supporting you.
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  It's just giving you the right information at
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  the right time.
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  And so, you know, clinicians are really quick
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  to tell us when a tool gets in
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  their way or they don't like it, and
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  I can say that because I'm a clinician.
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  And so the fact that we hear very
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  little about Dart from our frontline staff is
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  a really good sign. You know, no news
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  kind of means it's good news. I mean,
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  it's working the way that it should. But
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  our,
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  emergency room, physician advisor for sepsis who, you
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  know, knows a lot about sepsis, knows a
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  lot about quality, but also is an active
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  practicing,
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  emergency room doc told me that the thing
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  that he likes the most about Dart is
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  that it doesn't feel like it's another thing
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  to do because it's embedded so well in
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  his current workflow. So it's integrated in the
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  Cerner, which is the EMR that we use.
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  It's integrated into Vocera, which is our clinician
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  messaging,
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  platform. And then we even have desktop notifications
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  that show up,
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  that are just kind of those those nudges,
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  those reminders that something needs to happen for
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  your patient or we need to think about
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  something for your patient or new clinical data
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  has come,
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  has resulted, and we need to to pay
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  attention to it. And those insights show up,
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  you know, when they're already working, they're already
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  at their computer, or they already have their
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  handheld device on them. So it felt seamless
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  instead of an extra step or an extra
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  tool that you have to engage with.
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  And I feel like that's that's pretty rare
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  feedback when you're working with health care technology.
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  So we were we were excited,
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  to be able to introduce something like that
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  into our organization.
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  Yeah. I think the link between usability
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  and adoption is really, really key. Right? The
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  more usability you have, the better or the
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  higher the adoption rate is going to be
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  in a lot of cases, which is so
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  key. And you mentioned the, the emergency room
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  doctor, certainly. Is are there any other stories,
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  any other conversations that you've you've heard about
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  that that you have with with your staff
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  around this too?
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  Yeah. It's so funny. So on the inpatient
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  setting,
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  I think that for our inpatient providers, they
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  might have been a little bit more skeptical
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  of the process. And so when they get
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  a notification, they think, oh, it's just another
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  thing. Like, something, you know, that's telling me
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  to do something that's not pertinent to my
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  patient. And so then we kind of go
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  down you know, this tool was designed to
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  meet clinicians where they are, tell them what
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  they need to know about their patient in
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  real time from a sepsis perspective. And and
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  once we sort of go through, like, the
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  ping pong conversation of, well, what about this
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  and what about this? You know, they're able
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  to see, like, oh, this tool was designed
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  to give me what I need when I
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  need it, and I can now trust it.
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  And so, you know, I think our emergency
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  room physicians
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  are able to and maybe it's just the
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  nature of, you know, how those patients are
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  coming, how they're presenting,
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  and they process information in a different way.
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  But on the inpatient setting, it took maybe
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  a little bit more convincing.
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  But once they kind of better understood understood
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  the tool and how powerful it was, I
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  think that they're able to really trust it
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  more,
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  and really able to it's really kind of
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  helped promote collaboration in a way that we
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  weren't able to achieve before we introduced,
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  a technical solution to this.
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  And it's such a great example because, again,
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  it illustrates the importance of change management and
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  about having conversations with clinicians about not just,
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  hey, here's another tool that you have to
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  use now,
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  but actually saying, hey, Here's what this can
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  do for you, which is so key.
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  We started our conversation
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  talking about the fact that this is difficult
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  to measure. Right? Oftentimes, there's difficulty in determining
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  work how can we measure this? How can
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  we measure success? Etcetera. And and step one
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  performance, again, it's one of those things we're
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  trying. There are tries, but it's it's hard.
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  It remains hard. What are some of those
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  insights that you can share,
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  about how health systems can strategically
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  approach
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  this both from a regulatory perspective, regulatory compliance
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  rights, and meaningful patient outcome improvement? What are
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  some of the things that you want health
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  system leaders to know? Yeah.
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  Step one is tough. And anyone anyone that,
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  you know, works in health care or works
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  in a regulatory or quality knows that step
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  one is is extremely challenging.
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  One, just from a a conversation perspective, you
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  know, a lot of times we can be
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  doing really well with mortality. In our case,
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  we, you know, saw some really
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  significant
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  decreases
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  in our mortality outcomes, which is overall what
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  we're trying to impact. We're trying to save
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  lives, but our step one compliance was not
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  following suit. And so,
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  that tells me that step one is not
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  always a reflection of how well you're caring
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  for your patients. It's kind of encompassing a
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  lot of other things too. And I think
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  there's good intentions behind SEP one, but it
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  just is really tricky because it is all
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  or nothing. You have to pass every single
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  piece of every single element, that's required. And
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  so,
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  in a large particularly because we're a large
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  academic medical center, we found that that's been
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  extremely challenging.
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  You know, we have more than 1,300 beds.
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  We discharge,
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  almost five thousand patients a year with sepsis.
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  And so with that kind of volume,
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  we don't have the bandwidth to, you know,
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  follow each patient in real time and say,
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  make sure that they get this bundle element
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  and make sure that we're, you know, document
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  documenting this the right way. And so that's
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  why we have had to lean so much
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  on those good strong processes and tools
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  that can be applied at a system level
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  that sort of act like a safety net.
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  They're kind of just in the background waiting
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  to be used and waiting to sort of
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  nudge the clinician with the right information at
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  the right time.
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  And, again, it really comes back to that
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  three legged stool of people, process, and technology.
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  You know, and Dart being that technology piece
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  that gives them feedback and, like, visibility
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  into where we are with the bundle without
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  adding more work. Because I don't want my
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  clinicians
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  to be sitting at the bedside thinking, okay.
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  I'm waiting for the exact right moment when
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  it's when I'm allowed to document the sepsis
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  reevaluation note. That's not what I want them
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  to be doing. I want them to be
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  focusing on patient care. And so by using
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  the technology kind of arm of this analogy,
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  we're able to think about how to set
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  them up to get the right information. Again,
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  the right information at the right time to
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  the right clinician.
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  And so even though our step one compliance
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  hasn't risen as fast as our mortality rates
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  have fallen, we have been able to avoid
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  any value based purchasing penalties this year, which
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  is a really big deal, and I know
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  that everyone really cares about that.
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  But we still wanna, you know, keep getting
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  better. And so our goal for for next
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  year is to hit 80% compliance, which is
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  a tall order. But,
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  the good thing is that we have DART
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  to kind of help test and refine changes,
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  kind of like a sandbox to help us
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  test test things out and see what works
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  to help us meet that goal.
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  So technology in this, because you mentioned Dart,
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  again, that's really the critical enabler in being
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  able to at least make a step in
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  the right direction.
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  Yes. Absolutely. And Dart has, is really a
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  configurable
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  tool. You know, when we first designed
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  Dart in our setting, we thought, like, oh,
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  clinicians will engage with it this way, and
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  this is how we design it. And, you
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  know, for anything, once you put it into
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  place, it's not gonna work exactly how you
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  anticipated. And so being able to sort of
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  revisit different ways that our clinicians interact with
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  that tool,
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  based on real world, you know, examples, we're
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  able to say, okay. Our clinicians aren't gonna
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  go here to receive this information, but they
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  are gonna go to this place. Or they
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  don't wanna be notified in this way, but
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  they do wanna be notified in this way.
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  And so, again, being able to kind of
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  push and pull levers with the dart tool
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  to be able to meet clinicians where they
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  are,
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  has been really key,
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  in driving success.
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  Yeah.
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  Mary Grace, thank you again so much for
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  all of these insights. This is such an
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  incredible conversation. I I wanna turn the floor
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  over to you. Anything else that you'd like
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  to share? Any final thoughts on this topic?
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  Anything else that we we haven't touched on
• 12:37
  that's really important for folks to understand?
• 12:40
  Yeah. I think the the perspective that we've
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  taken, which I think has been really effective,
• 12:45
  is to really focus on our frontline staff
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  from the quality perspective.
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  You know, I think we're all here for
• 12:51
  the patients. That's why we, you know, decided
• 12:53
  to go into health care in the first
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  place. But if we sort of back that
• 12:56
  upstream a little bit and focus on supporting
• 12:58
  our clinicians at the bedside who are caring
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  for our patients and giving them the tools
• 13:03
  and the workflows that they need, they're able
• 13:05
  to be set up for success and really
• 13:07
  deliver the best care to their patients.
• 13:09
  And, you know, it the DART tool really
• 13:11
  gives us confidence that we're able to, again,
• 13:13
  kinda push and pull up on those levers
• 13:15
  to make sure that we find the right
• 13:16
  combination of things,
• 13:18
  and keep learning learning and adapting to our
• 13:20
  systems, which are changing every day. So Yes.
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  Keep up with all that is hard, but,
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  we're we're making it through.
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  It's building the three legged stool together. Right?
• 13:30
  Yeah.
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  That's really, really key. Mary Grace, thanks you
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  again for being here today. Thank you for
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  your great insights. Fantastic to have you. Yeah.
• 13:38
  Thank you so much, Lucas. And we also
• 13:40
  want to thank our podcast sponsor, Zebra Technologies
• 13:42
  and Ambien Clinical Analytics.
• 13:44
  You could tune into more podcasts from Becker's
• 13:46
  Healthcare by visiting our podcast page at beckershospitalreview.com.