Sepsis Surveillance and Response Models
By Drew Flaada, Chief Technology Officer, Ambient Clinical Analytics
In recognizing and treating sepsis, there are effectively three things that are critical to sepsis surveillance, improved clinical outcomes and reduced mortality for effected patients:
While deploying Sepsis DART™ in hospital systems across the U.S. we see three basic response models at work, depending on the quality systems, management processes, and investment levels at the hospital.
Alert/remind all responsible team members
In this model it is critical to be able to identify specifically who (nurses, physicians, residents, other providers) is currently responsible for a given patient, either in the EMR or some other electronic and accessible scheduling system. With this approach a targeted subset of nurses and providers are notified for both the initial detection of possible sepsis via sepsis surveillance, as well as reminded about the delivery of incomplete care elements.
Pros: Communications are direct and targeted. Caregivers who are working on that patient quickly know what needs to be done.
Cons: Many scheduling systems are not accessible (i.e. maybe manual) so current care team not identifiable. Alerting and reminders for multiple patients simultaneously may become confusing.
Alert/remind responsible team members PLUS Sepsis Response
This model is an extension of the first, with an important addition of a dedicated sepsis coordinator or sepsis response team (depending on the hospital’s structure). With this approach it is less critical that an up to the second responsible staff list be maintained, as the central sepsis response person or group is in place to ensure follow through. The workflow around this kind of approach also helps to ensure consistency of diagnosis and treatment delivery, and the response team engagement can ensure sepsis quality improvement objectives remain at the forefront of response.
Pros: Improved consistency of diagnosis and care delivery. Involvement of response team can improve timeliness of response and treatment.
Cons: Requires local investment in a sepsis coordinator or sepsis response team function. Sepsis coordinator may not be a 24x7 position, so response model may be inconsistent based on day of week and time of day.
“Clinical control tower”
With this model a central monitoring team is employed, and all potential sepsis surveillance alerts and follow on reminders for incomplete bundle elements will also appear in the “control tower” that is monitoring all sepsis cases. This can be an entity created and staffed to exclusively focus on sepsis, or an existing group within a hospital system that is already providing 24x7 coverage (e.g. a tele-ICU center). In the clinical control tower model, sepsis surveillance and monitoring are added to their charter. It is up to the “control tower team” to review the patient’s record when a potential detection alert or bundle element notification is received, and then engage the bedside team for appropriate action.
Pros: Alerts and reminders are centrally managed and follow up can ensure concerns are addressed. The clinical control tower model is not subject to ongoing patient care distractions that can lead to unserved alerts or incomplete care delivery. Care consistency and focus is paramount. This methodology is not dependent on an up to the second staffing system tied to the patient ID.
Cons: Requires local investment in a 24x7 staffed “control tower” for sepsis or requires an analogous prior organization to take on the sepsis function. May be a lag between an alert/reminder and when the beside team can be contacted.
Any of these three models, coupled with the right technical automation solution (like Sepsis DART™) can yield substantial patient care improvements and cost reductions. The model that will work for an individual health system will depend on the system design and workflow of each hospital, and there are many differences, especially in the quality of the staffing information electronically available, and the investment made in centralized functions like sepsis response and central incidence management.
For more information from Ambient Clinical Analytics on ‘Sepsis Surveillance Response Models’ for your organization please contact drew.flaada@ambientclinical.com.
About Ambient Clinical Analytics - As an industry leader, Ambient is supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver data visualization, communication, and analytics based clinical decision support solutions.
Ambient’s AWARE™ solution is an exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platform. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient is also deploying the AWARE™ family of solutions, to help manage COVID-19. Ambient’s Virtual ICU platforms are ideal for dealing with current and possible future outbreaks.
¹Jozwiak M, Monnet X, Teboul JL., Implementing sepsis bundles, NCBI, September, 2016
In recognizing and treating sepsis, there are effectively three things that are critical to sepsis surveillance, improved clinical outcomes and reduced mortality for effected patients:
-
- Early detection. Ideally this should be automated with sepsis surveillance happening in the background so the potential development of sepsis can be brought to the attention of a provider or nurse while they are providing care to their patients. Subtle changes may be taking place in the patient’s condition, and often the care team can become very focused on the current problem(s) they are dealing with and might miss the onset of sepsis.
-
- Early intervention. Detecting sepsis in a patient is great but does absolutely no good unless a provider steps in, reviews the patient’s case, and declares that the patient does indeed have sepsis, and then begin to institute treatment.
- Timely delivery of all required care elements. The treatment bundle for sepsis is well defined, and if delivered comprehensively and within the defined time windows, provides remarkable improvements in not only the survivability of sepsis, but also in reductions of total care and length of hospitalization for patients who acquire sepsis. They (bundles) induced more consistent and timely application of evidence-based care and reduced practice variability.¹
While deploying Sepsis DART™ in hospital systems across the U.S. we see three basic response models at work, depending on the quality systems, management processes, and investment levels at the hospital.
Alert/remind all responsible team members
In this model it is critical to be able to identify specifically who (nurses, physicians, residents, other providers) is currently responsible for a given patient, either in the EMR or some other electronic and accessible scheduling system. With this approach a targeted subset of nurses and providers are notified for both the initial detection of possible sepsis via sepsis surveillance, as well as reminded about the delivery of incomplete care elements.
Pros: Communications are direct and targeted. Caregivers who are working on that patient quickly know what needs to be done.
Cons: Many scheduling systems are not accessible (i.e. maybe manual) so current care team not identifiable. Alerting and reminders for multiple patients simultaneously may become confusing.
Alert/remind responsible team members PLUS Sepsis Response
This model is an extension of the first, with an important addition of a dedicated sepsis coordinator or sepsis response team (depending on the hospital’s structure). With this approach it is less critical that an up to the second responsible staff list be maintained, as the central sepsis response person or group is in place to ensure follow through. The workflow around this kind of approach also helps to ensure consistency of diagnosis and treatment delivery, and the response team engagement can ensure sepsis quality improvement objectives remain at the forefront of response.
Pros: Improved consistency of diagnosis and care delivery. Involvement of response team can improve timeliness of response and treatment.
Cons: Requires local investment in a sepsis coordinator or sepsis response team function. Sepsis coordinator may not be a 24x7 position, so response model may be inconsistent based on day of week and time of day.
“Clinical control tower”
With this model a central monitoring team is employed, and all potential sepsis surveillance alerts and follow on reminders for incomplete bundle elements will also appear in the “control tower” that is monitoring all sepsis cases. This can be an entity created and staffed to exclusively focus on sepsis, or an existing group within a hospital system that is already providing 24x7 coverage (e.g. a tele-ICU center). In the clinical control tower model, sepsis surveillance and monitoring are added to their charter. It is up to the “control tower team” to review the patient’s record when a potential detection alert or bundle element notification is received, and then engage the bedside team for appropriate action.
Pros: Alerts and reminders are centrally managed and follow up can ensure concerns are addressed. The clinical control tower model is not subject to ongoing patient care distractions that can lead to unserved alerts or incomplete care delivery. Care consistency and focus is paramount. This methodology is not dependent on an up to the second staffing system tied to the patient ID.
Cons: Requires local investment in a 24x7 staffed “control tower” for sepsis or requires an analogous prior organization to take on the sepsis function. May be a lag between an alert/reminder and when the beside team can be contacted.
Any of these three models, coupled with the right technical automation solution (like Sepsis DART™) can yield substantial patient care improvements and cost reductions. The model that will work for an individual health system will depend on the system design and workflow of each hospital, and there are many differences, especially in the quality of the staffing information electronically available, and the investment made in centralized functions like sepsis response and central incidence management.
For more information from Ambient Clinical Analytics on ‘Sepsis Surveillance Response Models’ for your organization please contact drew.flaada@ambientclinical.com.
About Ambient Clinical Analytics - As an industry leader, Ambient is supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver data visualization, communication, and analytics based clinical decision support solutions.
Ambient’s AWARE™ solution is an exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platform. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient is also deploying the AWARE™ family of solutions, to help manage COVID-19. Ambient’s Virtual ICU platforms are ideal for dealing with current and possible future outbreaks.
¹Jozwiak M, Monnet X, Teboul JL., Implementing sepsis bundles, NCBI, September, 2016