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EHR Saves Lives: Cuts Sepsis Deaths By 25%

Orlando Regional Medical Center

“Sepsis is preventable, and at Orlando Health we have set a high priority on infection control as our quality initiative. (Allscripts) Sunrise EHR is an essential part of our initiative to eradicate central line-associated bloodstream infection and catheter-related urinary tract infection. The capabilities of Sunrise significantly help with these efforts.”

– Michael L. Cheatham, MD, FACS, FCCM, Director, Surgical Intensive Care Units, Orlando Health

Most of us are familiar with sepsis — a serious medical condition caused by an overwhelming immune response to basically a whole body infection. It’s one of the leading causes of death in hospital ICUs. Every year, severe sepsis strikes about 750,000 Americans. Somewhere between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined.

MLMs are the key

The key to beating sepsis is to detect it preemptively and intervene before things go south.  At Orlando Health, clinicians knew technology was a key to early identification of sepsis, enabling a quick response and resolution.  They figured out a way to significantly reduce the mortality rate from sepsis through a combination of advanced clinical decision support (aCDS) – built on Sunrise’s underlying Microsoft .NET architecture – and rapid response teams.

One of Florida’s most comprehensive private, not-for-profit healthcare networks, Orlando Health includes MD Anderson Cancer Center Orlando, Orlando Regional Medical Center and six other major hospitals, as well as thousands of employed and affiliated physicians.  Starting in 2008, under the leadership of CIO Rick Schooler (recently named CIO of the Year by HIMSS and CHIME), Orlando Health implemented a series of technology advances and workflow changes designed to identify and treat patients with sepsis within one hour of their arrival.  

The solution includes an MLM-based automated assessment within the hospital’s Sunrise acute care EHR that acts as an early-warning system; new sepsis order sets; a nursing documentation tool; and a structured note in the integrated ED information system. An automated “severe sepsis alert” code triggered by Sunrise ED brings a physician immediately to the patient’s bedside to implement care guidelines using specific sepsis order sets.  These automated tools operationalize the Surviving Sepsis Campaign’s international guidelines, walking clinicians through a step-by-step procedure that includes fluid resuscitation and antibiotic administration.

Significant Outcomes

At Orlando Regional Medical Center the program dramatically improved early identification of sepsis patients.  Comparing random samples of 22 patients from before implementation to 22 after implementation, Orlando Health increased the percentage of sepsis patients identified and treated within one hour of arrival from 0 percent to 73 percent.

That translates to a mortality rate reduction of 25 percent. Moreover, the program lowered the average length of stay for sepsis patients by 33 percent, from 10.5 days to 7.9 days.

Such a significant impact on mortality rates is a major accomplishment. If everyone delivered outcomes like Orlando Health, the U.S. healthcare system could save up to $17 billion every year. More importantly, we could save perhaps as many as 90,000 lives in the US.

It’s hard to argue with those numbers, especially when each one of them represents someone’s mother, father, brother, sister, spouse, child or friend.

QUESTION:

Have you implemented CDS-driven breakthroughs in quality care at your organization? I’d love to hear about it …

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

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