According to Lloyd Dean, president and CEO, "At Dignity Health, we are committed to developing partnerships and opportunities that harness the tremendous potential of technology, from improving the patient experience to providing caregivers with tools that will support their day-to-day care decisions."
Dignity Health, one of the largest health systems in the US, continues to demonstrate how its partnership with SAS and the use of advanced analytics can propel improvements in the delivery of health care. It recently presented several breakout sessions during HIMSS16 in Las Vegas.One of these sessions provides an excellent example of what Dean was talking about. Alyson D’Andrea and Ken Ferrell, representing the Dignity Health Insights (DHI) team, presented, Sepsis Biosurveillance at Dignity Health: Our Improvement Story.
The high cost of sepsis
Sepsis is the body’s overwhelming and sometimes life-threatening response to infection which can lead to tissue damage, organ failure and death. Patients who develop sepsis have an increased risk of complications and death and face higher health care costs and longer treatment.
The sepsis biosurveillance program represents the vision of the DHI team:
- Use big data and the world's best analytic tools in a secured cloud-environment to improve health outcomes and reduce costs.
- Use data across the continuum of care to improve outcomes of patients, increase knowledge, worker productivity, enable self-service access and markedly increase calculation speed and insights to decision makers.
During this session, D'Andrea and Ferrell explained the process for creating an internal dashboard for monitoring performance on several measures related to severe sepsis. Specifically, the tool and associated workflows implemented at 16 facilities (so far) helped reduce sepsis mortality rates. According to Dignity, an average of 69,000 people per month were monitored during this phase of the program.
For more than two decades, researchers and professional societies, including the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) have driven improved practice and consensus around severe sepsis.
Clinical leaders at DHI understood the importance of this initiative and looked for a way to use data from the electronic medical record with their SAS analytics platform to create a dashboard that shows the status on key performance indicators, allowing rapid intervention to save lives and improve the clinical outcomes of patients at risk for sepsis. This also supports generating evidence from actual practice to inform research and further refinement of evidence-based practice. This performance dashboard uses Hadoop technology, which significantly decreases storage cost, aggregates a variety of data sources, as well as enables enhanced security and flexibility in using the data.
Alerts and analytics
The DHI project strategy included identifying key performance indicators, implementing the St. John Sepsis Agent tool within the Cerner EHR system and creating a feedback loop to enable stakeholders to improve response time to the alert. The DHI team statistically validated the sepsis dashboard for accuracy and functionality. This included a "silent mode" evaluation, whereby manual chart review helped to correlate the St. John's Agent activity with patient discharge diagnosis. Subsequently, the team developed clinical alerts, carefully tweaking the sensitivity, specificity and relative risk to achieve just the right balance. Using Cerner’s alert, the team validated their findings and proposed design with internal stakeholders to ensure the result would achieve agreed goals for the project. A major focus of the DHI team was to direct the smarter alert to the person responsible for the patient at the time of the alert. This was defined as the primary care nurse, charge nurse, triage nurse and attending provider.
The team also worked to ensure the alerts fired at the right time, which was when the presence of sepsis in a patient was identified and 24-48 hours after the previous alert fired. The team also worked to ensure that the alerts filtered out patients, who were known to have sepsis at the start of their hospitalization. Alert filtering also included those who had cardiac surgery or extracorporeal membrane oxygenation (ECMO) within the previous 48 hours.
Better response, lower mortality
With initial implementation of the sepsis dashboard, the team soon began to see that higher nurse communication rates (nurses responding to alerts) correlated with lower mortality rates. They also were pleased to see fewer patients progressing to severe stages of sepsis. As with many improvement projects, they also discovered other opportunities for improvement such as achieving greater accuracy of clinical coding and clinician compliance with sepsis bundle orders.
As these programs continue, the DHI time will continue to focus on governance and goal ownership three or four meaningful key performance indicators, optimizing alerts around workflow and content and providing feedback to stakeholders in an actionable format.
Using its partnership with SAS, the DHI team has demonstrated a powerful use case for analytics in clinical care, and a strong argument for self-service visual analytics. Dignity Health has effectively enabled providers to better manage patient risk, decrease patient mortality, shorten length of stay in the intensive care unit and achieve overall reduction in cost of care. To learn more about the work at Dignity Health, please visit its website.