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Becker’s Healthcare Podcast
The Future of Sepsis Care: Building Systems That Support Patients and Clinicians
00:13:55
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- [00:00]
A
Hi, everyone. This is Lukas Voss with Becker's Healthcare. Thanks so much for tuning into the Becker's Healthcare podcast series. Today's episode is brought to you by Zebra Technologies and Ambien Clinical Analytics. Today we're going to talk about the future of sepsis care, building systems that support patients and clinicians. And joining me for today's discussion is Mary Grace Cox, Senior Director of Clinical Programs at UAB Medicine. Mia Grace, thanks so much for being here today. It's great to have you.
- [00:29]
B
Yes, thanks for having me.
- [00:31]
A
Absolutely. I want to start off with introductions for our audience. If you could just kick us off, share a little bit about yourself and your work in healthcare.
- [00:38]
B
Yeah, absolutely. So I'm a nurse by training and have been at UAB Medicine for a little over 14 years. I started at the bedside caring for oncology patients, and then in 2016, I moved into the quality space as our sepsis coordinator. And that's where I really saw how much we can impact patients by improving systems, not even just at the individual patient level, but really for systems and then supporting those clinicians that deliver care. And so now I focus on clinical effectiveness programs with sepsis being one of the biggest. And my role is all about really partnering with teams to improve outcomes and making their day to day work a little bit easier too.
- [01:19]
A
I was going to say, I feel like, again, we talk about sepsis quite a bit. It is one of the most pressing challenges in acute care, as you've mentioned. It's a big part of the conversation for everybody. From your perspective, what have we learned in recent years about improving patient outcomes in that space and what factors are most critical for moving the needles when we specifically look at mortality rates.
- [01:44]
B
Yeah, it's a great question, because mortality is something that is so challenging to move the dial on. And for sepsis, it's tricky too, because the science really hasn't changed that much. You know, it's early detection, early treatment, the things that we really know, and especially our clinicians, they know how to treat sepsis. But the real sort of progress comes from when we pull together people. So our clinicians, our experts in the field, and give them good process and technology to support that. My colleague Tim from Ambient really kind of honed in on that recently. And so clinicians bring that expertise, the process gives that consistency, and then the technology like the Ambient Dart tool, sort of ties it all together. And Dart helps us spot trends and variations really quickly so we can sort of adjust in real time. And that combination is really what's helped us drive down mortality in a meaningful way. And so I think, you know, if you've worked in the sepsis space for a long time, you know that there's no smoking gun. There's no one thing that says like, oh, this is going to fix our sepsis problem at whatever organization you're at. It's really about designing really good processes and systems that support clinicians. And so that's kind of what DART helps us to do. And dart, by the way, stands for the Detection and response Tool for sepsis. And so another kind of thing that DART has allowed us to do is, I think, kind of driven towards a cultural shift for us. We used to sort of have to continually campaign our clinicians and really go around and raise awareness and do all these kind of things for, you know, education. And we were educating people who already knew how to care for their patients with sepsis. And so it really wasn't that effective. And so we're able to sort of stop continually campaigning and drive us more toward that culture of continuous readiness where sepsis is not something the clinician has to be reminded about, it's just sort of embedded into their daily practice. And once I'm reminded, something a colleague once said at a conference that said, sepsis will highlight everything that's wrong with your organization. Which sounds pretty discouraging kind of at face value, but it really stuck with me because it's, you know, it's true because it touches so many patients across the hospital that you work in. You end up uncovering, you know, opportunities are not just tied to sepsis itself, but go almost like a magnifying glass. You kind of see gaps in communication and workflow and breakdowns and care coordination. And when you address those based on what you see with sepsis patients, you kind of benefit the entire organization at the same time.
- [04:10]
A
Yeah, and I'm so glad that we have you on because again, you bring such a, such an important perspective to this from the nurse's side, Right. From the clinician's perspective to this conversation. And you've touched on the technology piece and the change management part of it too, in terms of having those conversations with nurses about technology and how it impacts their day and how it does influence the day to day experience as well. I was wondering if you could elaborate a little bit on sort of that clinical innovation piece and how it's influenced clinicians, but then also what lessons that stand out to you from this process when it comes to supporting them effectively through technology.
- [04:46]
B
Yeah, absolutely. So I would say based on experience working clinically and then also based, you know, on my experience in the quality space, the best kind of technology solution is the kind that you do not notice at all. It just makes your job smoother. It just runs in the background, and you don't really know it's supporting you. It's just giving you the right information at the right time. And so, you know, clinic are really quick to tell us when a tool gets in their way or they don't like it. And I can say that because I'm a clinician. And so the fact that we hear very little about DART from our frontline staff is a really good sign. You know, no news kind of means it's good news and it's working the way that it should. But our emergency room physician advisor for sepsis, who, you know, knows a lot about sepsis, knows a lot about quality, but also is an active, practicing emergency room doc, told me that the thing that he likes the most about Dart is that it doesn't feel like it's another thing to. Because it's embedded so well in his current workflow. So it's integrated into Cerner, which is the EMR that we use. It's integrated into Vocera, which is our clinician messaging platform. And then we even have desktop notifications that show up that are just kind of those, those nudges, those reminders that something needs to happen for your patient, or we need to think about something for your patient, or new clinical data has come, has resulted, and we need to pay attention to it. And those insights show up, you know, when they're already working, they're already at their computer, they already have their handheld device on them. So it felt seamless instead of an extra step or an extra tool that you have to engage with. And I feel like that's. That's pretty rare feedback when you're working with healthcare technology. So we were, we were excited to be able to introduce something like that into our organization.
- [06:32]
A
Yeah, I think the link between usability and adoption is really, really key. Right. The more usability you have, the better or the higher the adoption rate is going to be in a lot of cases, which is so key. And you mentioned the emergency room doct, certainly. Are there any other stories, any other conversations that you've heard about that you have with your staff around this, too?
- [06:54]
B
Yeah, it's so funny. So on the inpatient setting, I think that for our inpatient providers, they might have been a little bit more skeptical of the process. And so when they get a notification, they think, oh, it's just another thing, like something, you know, that's telling me to do something that's not pertinent to my patient. And so then we kind of go down. You know, this tool was designed to meet clinicians where they are, tell them what they need to know about their patient in real time from a sepsis perspective. And once we sort of go through like the ping pong conversation of, well, what about this and what about this? You know, they're able to see like, oh, this tool was designed to give me what I need when I need it and I can now trust it. And so, you know, I think our emergency room physicians are able to. And maybe it's just the nature of, you know, how those patients are coming, how they're presenting, and they processed information in a different way. But on the inpatient setting, it took maybe a little bit more convincing. But once they kind of better understood the tool and how powerful it was, I think that they're able to really trust it more and really able to. It's really kind of helped promote collaboration in a way that we weren't able to achieve before we introduced a technical solution to this.
- [08:03]
A
And it's such a great example because again, it illustrates the importance of change management and about having conversations with clinicians about not just, hey, here's another tool that you have to use now, but actually saying, hey, here's what this can do for you, which is so key. We started our conversation talking about the fact that this is difficult to measure. Right. Oftentimes there's difficulty in determining how can we measure this, how can we measure success, et cetera, and set one performance? Again, it's one of those things we're trying. There are tries, but it's hard. It remains hard. What are some of those insights that you can share about how health systems can strategically approach this, both from a regulatory perspective, regulatory compliance rights and meaningful patient outcome improvement. Some of the things that you want health system leaders to know.
- [08:52]
B
Yeah, step one is tough. And anyone, anyone that, you know, works in healthcare or works in regulatory or quality knows that step one is, is extremely challenging. One just from a conversation perspective, you know, a lot of times we can be doing really well with mortality. In our case, we, you know, saw some really significant decreases in our mortality outcomes, which is overall what we're trying to impact. We're trying to save lives. But our step one compliance was not following suit. And so that tells me that step one is not always a reflection of how well you're caring for your patients. It's kind of encompassing a lot of other things too. And I think there's good intentions behind Sep1, but it just is really tricky because it is all or nothing. You have to pass every single piece of every single element that's required. And so in a large, particularly because we're a large academic medical center, we found that that's been extremely challenging. You know, we have more than 1300 beds, we discharge almost 5000 patients a year with step sepsis. And so with that kind of volume, we don't have the bandwidth to, you know, follow each patient in real time and say, make sure that they get this bundle element and make sure that we're, you know, document documenting this the right way. And so that's why we have had to lean so much on those good strong processes and tools that can be applied at a system level that sort of act like a safety net. They're kind of just in the background waiting to be used and waiting to sort of nudge the clinician with the right information at the right time. And again, it really comes back to that three legged stool of people, process and technology, and Dart being that technology piece that gives them feedback and visibility into where we are with the bundle without adding more work. Because I don't want my clinicians to be sitting at the bedside thinking, okay, I'm waiting for the exact right moment when I'm allowed to document the sepsis reevaluation. Note that's not what I want them to be doing. I want them to be focusing on patient care. And so by using the technology kind of arm of this analogy, we're able to think about how to set them up to get the right information again, the right information at the right time to the right clinician. And so even though our step one compliance hasn't risen as fast as our mortality rates have fallen, we have been able to avoid any value based purchasing penalties this year, which is a really big deal. And I know that everyone really cares about that, but we still want to, you know, keep getting better. And so our goal for, for next year Is to hit 80% compliance, which is a tall order. But the good thing is that we have Dart to kind of help test and refine changes, kind of like a sandbox to help us test things out and see what works to help us meet that goal.
- [11:28]
A
So technology in this case you mentioned Dart again, that's really the critical enabler in being able to at least make a step in the right direction.
- [11:37]
B
Yes, absolutely. And Dart has, is really a configurable tool, you know, when we first designed DART in our setting, we thought like, oh, clinicians will engage with it this way and this is how we design it. And you know, for anything, once you put it into place, it's not going to work exactly how you anticipated. And so being able to sort of revisit different ways that our clinicians interact with that tool based on real world, you know, examples, we're able to say, okay, our clinicians aren't going to go here to receive this information, but they are going to go to this place. Or they don't want to be notified in this way, but they do want to be notified in this way. And so again, being able to kind of push and pull levers with, with the DART tool to be able to meet clinicians where they are has been really key in driving success.
- [12:25]
A
Yeah. Mary Grace, thank you again so much for all of these insights. It was such an incredible conversation. I want to turn the floor over to you. Anything else that you'd like to share? Any final thoughts on this topic? Anything else that we haven't touched on that's really important for folks to understand?
- [12:40]
B
Yeah, I think the perspective that we've taken, which I think has been really effective, is to really focus on our frontline staff from the quality perspective. You know, I think we're all here for the patients. That's why we, you know, decided to go into healthcare in the first place. But if we sort of back that upstream a little bit and focus on supporting our clinicians at the bedside who are caring for our patients and giving them the tools and the workflows that they need, they're able to be set up for success and really deliver the best care to their patients. And, you know, the DART tool really gives us confidence that we're able to again, kind of push and pull up on those levers to make sure that we find the right combination of things and keep learning, learning and adapting to our systems, which are changing every day. So keep up with all that is hard, but we're making it through.
- [13:28]
A
It's building the three legged stool together. Right. That's really, really key. Mary Grace, thanks you again for being here today. Thank you for your great insights. Fantastic to have you.
- [13:38]
B
Yeah, thank you so much, Lucas.
- [13:40]
A
And we also want to thank our podcast sponsor, Zebra Technologies and Ambient Clinical Analytics. You can tune into more podcasts from Becker's Healthcare there by visiting our podcast page at beckershospitalreview. Com.