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Cape Regional Medical Center (CRMC), an affiliate of the University of Pennsylvania Health System, is a general medical and surgical community hospital in Cape May Court House, New Jersey. As the sole hospital in Cape May County, CRMC serves its local community and more than one million seasonal visitors each year. In February 2017, CRMC implemented InSight in the emergency department, intensive care unit, and acute care wards with the goals of better managing sepsis, improving patient outcomes, and reducing sepsis-related spending.
To smoothly integrate InSight into the CRMC clinical workflow, the Dascena onboarding team collected feedback from alert respondents and sepsis care teams. The onboarding team and clinical leadership collaboratively introduced iterative changes through regular PDSA (plan-do-study-act) cycles.
In particular, the alert delivery modality, content, and timing were optimized. Based on initial input from hospitalists and ED leadership, the alert was programmed to be an automated call containing patient ID, unit, and bed number with a six hour “snooze” feature. After go-live, alert respondents requested the inclusion of patient name, three repetitions of the alert content, and placement of multiple calls if initial calls were missed. Each of these features were implemented within one week of the request. Similarly, alerting thresholds were adjusted through the PDSA process to catch as many patients as possible while minimizing false alerts.
After implementing InSight, CRMC saw a 9.55% reduction in average sepsis-related hospital length of stay (LOS), a 60.24% reduction in sepsis-related in-hospital mortality rate, and a 50.14% reduction in sepsis-related 30-day readmission rate. These decreases were calculated from the reductions observed in the first post-implementation period (Feb 2017 to Mar 2017; designated green in the figure below), the second post-implementation period (Mar 2017 to Apr 2017; designated purple), and the post-implementation steady state period (Apr 2017 to May 2017; designated black) and were compared to the baseline data (Nov 2016 to Jan 2017; designated blue). The first PDSA cycle occurred before the first post-implementation period and the other two PDSA cycles were completed before the second period. The steady state commenced one month after the final PDSA cycle to determine whether the improvements were sustained. To determine sepsis-related outcomes, analysis was limited to patients who met at least two Systemic Inflammatory Response Syndrome (SIRS) criteria at some point during their stay (n = 1,328).
During the two-month period after InSight implementation, CRMC’s SEP-1 severe sepsis 3-hour bundle compliance rate was 72.7%, outperforming the 2016 annual average compliance rate of 49%. In the post-implementation period, there were significant decreases in time to antibiotic, blood culture, and fluid order placement relative to time of documented suspicion of infection. Earlier intervention, especially earlier antibiotic administration, likely contributed to the decrease in sepsis-related mortality seen during the InSight implementation period.
These sepsis care improvements may lead to a positive financial impact. The average cost of sepsis care at CRMC amounts to approximately $2,311 each day, and there are about 300 sepsis cases per month. CRMC’s shortened average LOS and reduced readmission rate potentially translate to an estimated $3.6 million in annual cost savings for the Cape Regional Health System.