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Becker’s Healthcare Podcast
Dr. Christopher Thomas, Vice President and Chief Quality Officer at Franciscan Missionaries of Our Lady Health System
00:18:44
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- [00:00]
A
This is Alan Condon with the Beckers Healthcare podcast. And today I'm delighted to be joined by Dr. Christopher Thomas, Vice President and Chief Quality Officer of Franciscan Missionaries of Our Lady Health system. That's a 10 hospital nonprofit health system headquartered in Baton Rouge, Louisiana. Dr. Thomas, pleasure to have you on the podcast with us today. Before we dive into our discussion, I'd love to just firstly hand the floor over to you, hear a little bit more about your background and your role at the health system.
- [00:33]
B
Yeah, happy to be on. I am a pulmonary and critical care physician by training. Moved into that area because I was concerned and wanted to kind of investigate critical illness, and that's how I ended up in sepsis. I grew up in a small town in West Virginia, and then when I joined our health system here was afforded the opportunity to think about staying safety at scale and how we can improve the overall outcome of many patients. So moved into the role of Chief Quality Officer after a stint as Medical Director of system Quality and Patient safety. Over the last three to four years, that's been kind of a journey of moving from the research elements over to the application of evidence based medicine, which for us is quality, and trying to bridge the gap in between a publication that says we should do a certain intervention for patients and then the time it takes us to get every patient within our health system to be able to realize those benefits.
- [01:37]
A
Got it. And I really appreciate the brief kind of background and perspective there. And I understand a big, big core part of your focus, like you said, moving from that research to the application of evidence based medicine. And I understand you recently led a landmark initiative that achieves a 39% reduction in sepsis mortality at the health system. I'm eager and excited to hear more about this significant achievement. So to kick things off, could you begin by walking us through the moment that you realized that this was a critical issue that your health system needed to tackle?
- [02:14]
B
When we look at the major reasons patients come into hospitals and when they leave hospitals, they don't return to the same level of function to their families. The disease that we become the most concerned with, his sepsis. So as we began to evaluate how do we think of all of the patients who are coming into our health system and what's the most impactful disease that would get patients back to their dinner tables and get them to living, we decided this was the one. If you ask me retrospectively whether that was a great decision, I would tell you I probably should have started in something that was easier. But globally, for us, when you come off of the pandemic. What you're really trying to understand is patients have a risk, risk to develop an infection. And then when they develop an infection, the body either responds appropriately or it responds in an abnormal way and kind and creates this area where all of the organs respond to the presence of infection. We were really interested in that. The majority of people who show up to the ER have an infection, and if they have an infection in that group, who is going to be those who get really sick and who are going to be those that we can say, I think you're okay for right now and you can go home. So in taking care of our communities that we're privileged to serve, it was the disease that came to our, our forefront and said, if we're going to be really good for our hospitals in Louisiana, Mississippi, we need to be really good at this disease. And that's kind of when we first started to look at it from a personal journey. I actually experienced this with my father. And so it's always been a personal evaluation of, hey, he had a routine procedure, he got an infection, and then he became critically ill. And so I began to think before I ever joined our health system, what would that be like if it wasn't my dad, but it was someone else's family? And could I be confident as the quality officer for us, that every single time, every single patient would get the same approach and get the same results that he was fortunate to have When I was in medical school, I'm curious.
- [04:24]
A
To just follow up out of those patients that present to the emergency department, can you talk us a little bit about how you identify those patients with infections that were going to be really sick and needed to be treated and stayed perhaps in the hospital, and those patients who presented in the edge with an infection, but were perhaps healthy and strong enough to fight that infection and maybe return home?
- [04:49]
B
Yeah. This is a fantastic question and one that's really critical. Across the United States, there are many diseases where we're very clear the severity of illness related to the test that we have. So, for example, if you come in with chest pain and you have a very specific change on your ekg, so something that we call a ST elevation myocardial infarction. We take you immediately to the cath lab, and we know that the patients who do not have that specific change won't have a severity of an illness as that patient. We know that in stroke care that when you come in and we get a CAT scan and we see a blockage in a vessel in Your brain that we need to be able in our comprehensive stroke centers to go and get that clot out for us in sepsis. Up to about three years ago, when we began this journey, what I would tell you is we just were forced to assume that everyone who had an infection was at risk to develop an abnormal response and get markedly sicker. And so we by definition over treated all the patients. So you brought up a really great point. That meant that there were people who we watched in the hospital who probably were able to go home. And then on the other side of it, you had to be perfect. And in your assessment of who were the ones that were going to get sick. And it was less elite than our management of things like trauma and heart attack and stroke. It just didn't meet the same standard of where we were trying to go from an excellence perspective. So that was the very first question we looked at, is what do we need? How do we create a structure that takes those patients who, as you described, some could go home and some are going to get really sick and. And how do we figure out who is who? And that led us to both the research and then implementation of a new diagnostic test that was developed. It's brought by a company called Cytovale and Intellisep. And so it was a key feature for us in creating this pathway to being able to pick out the right patient at the right time, as opposed to all of the patients getting everything.
- [06:59]
A
Got it. That makes a ton of sense. And it was kind of the first question that sprang into my mind when I was reading about this study. And this. The significant achievement on your part and everyone at your team, at the health system, ties right into my next question, which I wanted to pry on. What were the biggest gaps in sepsis triage and management that you identified early in the process? Particularly like we said in the emergency department.
- [07:25]
B
Yeah, I think we didn't use our talent well, to be honest. And this is a challenge. Across the United States, we had experts in being able to suspect people of having infections. That was our nurse triage team. We weren't using them and giving them tools in a way that could be repeatable. And every single time. So that was the first step. The second step is we needed to listen to our teams who said, hey, there are procedures that we want to do to patients to help them, and then there are procedures we're doing the patients that don't help them. That was something called blood cultures. So we listened to our phlebotomy team and our nurses to kind of Start a process that started with the nurses and a nurse initiated order, set and then develop a set of labs that told us who was at high risk and who was not. And that new addition in that triage is. That's where the intellisept test for us became super helpful. It allowed us to change to look at the patients and say, you are very sick and we're going to come give you as much treatment early as possible. And then it allowed us to look at the patients where it was very clear over 97 to 98% of the time they were not going to progress to this threatening thing that we call sepsis and allow us to treat them in an individual manner, personalized still, but not expose them to all of the testing and all of the procedures that are necessary when the patients are really critically ill. So the take home from that is triage had to be optimized. And then we had to have a pathway where we could get to something that told us you're going to get sick or you're not and then allow our teams of just elite emergency department physicians who they're going to go to the first and get to the amount of treatment that's necessary in terms of antibiotics and then evaluating them and having a good conversation with their families about how concerned we are about them.
- [09:16]
A
Curious. If you could just talk one bit more about rallying the talent, the staff, the clinicians at your organization, kind of what you did specifically differently in terms of the tools you provided them, the resources, perhaps the education to really kind of really help secure that, buy in and drive towards these results.
- [09:35]
B
Yeah, we have a phenomenal performance improvement team here at our Lady Lake Health and as part of the system. And the first thing we did was took the voice of those team members who said we want to get several things correct. We want to make sure that we get into the waiting room and pull out patients who are sick, who may not look really sick. We want to make sure that we have this correct recognition of the patients who do have sepsis. We want to make sure that the patients were taken care of, stay in the hospital for a very short period of time or shorter compared to others. We want to make sure that they are able to survive. And then the teams also told us a really interesting concept that's critical to this is they also said, we also want to look at the patients who before we thought were septic but are really sick and who aren't septic. And we want to have a pathway where we can pivot off of them so we call this people, process and pivot. We took the talent of the people, that's the, er, the phlebotomist, the pharmacist, our performance improvement team, we put them in a room every week and we looked at every single result over an entire year and continued to iteratively improve the process that we were creating. We let them tell us what was working and what wasn't working. And so we could get to like a final really good structure that you see in those results of the reduction in mortality relative by 39%, a length of stay, reduction of 0.76. But more specifically, when you put those people together in a room and performance improvement, they then begin to drive the change related to other things surrounding the disease. And so what we learned is that they were much more comfortable in having the conversation about sepsis with the patients. They were able to enhance the conversation about risk with the patients. And so the biggest part about this is the ability to implement a really novel diagnostic, but at the same time kind of estimate the talent of your internal team, recognize when they're really supremely talented, and then put them into a process and a structure where they can show that talent. And that's what we've been able to do, not only for where the first pilot location in the United States was of this process, or Leela Lake Regional Medical center in Baton Rouge, but now in the rest of our health system to repeat and replicate that kind of process. And so it's been really rewarding.
- [12:01]
A
Fantastic. The three Ps, people, process and pivot, love that. Obviously, the results really speak for themselves. I mean, hats off to you and the fantastic team around you. What are the next steps in terms of driving even further, even more substantial results around sepsis? How are you looking to continue the great work that you're doing across the health system?
- [12:25]
B
Yeah, I think this just comes back to listening to the team. So here's what they've told us before we started this process versus after the after process. For every 110 patients we put through this structure, we save one life. For every patient, comparatively from before and after, who comes up with a high risk test, we save. It takes about 24 of those tests. So the number needed to treat based on that high risk results, 24. So we're taking those numbers and we're saying, where else in this journey of the pathway of the sepsis patient can we help further improve the care? So we're now looking at how our antibiotic use and which antibiotics that we're using. How can we optimize that, meaning if you don't need a very broad antibiotic, let's not get it to you. Let's be very specific and tailored. We're also beginning to look at, well, what. Who are those patients that we think we're going to need to admit to the hospital, but the next 24 hours to 36 hours is going to dictate to us whether you're going to potentially get sicker or whether you're going to get to go home. So we're focusing in on them. That's for us, a process that we call rescuing the patient. So recognizing the disease and making sure that if they were going to get sicker, we have to think about the rescue. And then on the last part, this is also about adding other data to this, this new novel way to look at sepsis. So if I have my dad, who would have come in and he talks to our emergency department team and they triage him and then he gets the test and the test says he's high risk, and then as we think about him being high risk, what are the other things that we need to do for him to ensure that he gets to go home? And so adding things like a structured mobility program, because we know sepsis patients get weaker, which we have, and let's then look about what his needs are going to be two and three days later, so that when he's discharged, we want to make sure that he understands the disease he had and that he sees his primary care physician within the next seven days. So really thinking about this holistically, this process looked about the inpatient ability to triage and identify a sepsis patient. And now, as you take a step back, what we've begun to really think is we're world class in the results, in recognition, we're world class in the results of treatment, but we'd like to be world class in preventing you from ever needing to come into the hospital. And then if you had to, if it was unfortunate enough that you get infection and you get sepsis, what are we doing on the backside that's really meaningful? And the same results that we've seen here, sometimes we think meeting is just checking a box to do something. What our teams are pushing us to do is if we do something, I want to make sure that it helps someone's mother, brother, you know, sister, father. And so really just a congratulations to the team to continue to push us and what we do, because I think many places would stop at this level of success in terms of length of stay. And mortality. But they're pushing us now to new areas, thinking about if we're a community, if their family members show up to our ER and they bring them in, they want to make sure that we're doing the same for every member of the community we would do their family. So they keep telling us new pieces of this kind of learning health pathway that we need to get better with.
- [16:00]
A
Yeah, I mean, fantastic story. Fantastic results. So greatly appreciate and so greatly respect the work that you and your fantastic clinical teams are doing across the board. Last question. Dr. Thomas, before I let you go, I think for any other clinical leaders listening to the podcast, physician leaders, teams at hospitals, health systems across the country looking to achieve similar success in terms of improving sepsis care across their organizations. And is there one or two, maybe key pieces of advice you give them?
- [16:33]
B
Yeah, I think number one is your teams and their talent are critical. Use them, listen to their feedback, go to where they do their work and get their ideas. That, for us, was revolutionary. It changed us from an old way of thinking to a new way of thinking. After you get their opinion, be willing to do things that are innovative that others would say has not been done before, like. Like we have, and find partners who are willing to do it differently. Our partner here was a company that makes this test called intellisept. We were brave enough, I think, from our team to say we want to use a novel diagnostic, be better. And so for other health system leaders, my recommendation is sometimes the courage is in changing something that was already working to try to get to elite, and then with the way technology is developing, be willing to seek out new personalized kind of tests. This test that we use looks at the actual biology of the individual patient you're looking at, which is a revolutionary change from just an aggregate of vitals and maybe a little bit of history. So for health system leaders, be willing to take what you do really, really now and go to a version 2.0, or do that thing that we call a pivot, pivot with your people in your process and add something in that you think is gonna have really good patient center goals. And then be willing to tell your teams what is and is not working, because you can essentially supersize your results, and I think you can escalate and accelerate the process of improvement over a shorter timeline. And that's what we're here to do from a health care perspective.
- [18:22]
A
I think some fantastic words of wisdom, key takeaways and advice for any of our clinical leaders here as we round out our discussion. Dr. Thomas. So greatly appreciate you taking the time out of your busy schedule. Really, really enjoyed this conversation, and I look forward to connecting with you again down the line.
- [18:38]
B
Absolutely. Thank you so much for having me.