Using digital technology to improve sepsis care
Dr Anne Kinderlerer, consultant rheumatologist, is the clinical coach for the Trust’s sepsis big room, a weekly meeting that unites people, data and patient stories to drive improvement. The big room is one of a number of techniques developed by the Flow Coaching Academy in Sheffield to improve complex care pathways that are now being implemented at Imperial in our own Flow Coaching Academy.
Each week since May 2017, the sepsis big room has been looking at how the management of sepsis at the Trust can be improved to ensure the earliest possible identification and treatment. Sepsis is a rare but serious complication of an infection. Here, Dr Kinderlerer shares some reflections about the use of digital technology in driving improvements and explains how you can get involved in the sepsis big room.
Think about when you’re in a restaurant: the waiter hands you a menu so that you can choose what you want to eat. But that menu actually serves two functions: it allows you to make a choice about what you’d like to eat and its presence on the table signals to the waiter that you haven’t ordered your food yet.
Traditional paper patient records in hospitals have a variety of functions too, which became apparent in our sepsis big room. Prior to the introduction of electronic systems, when a doctor wanted to give antibiotics to a patient urgently, they wrote the prescription on a paper drug chart and gave it to the nurse saying, “Please give this antibiotic to the patient now.” The paper drug chart not only defined the type and dose of antibiotics to be given, it acted as a token to signal the urgency of the prescription and it signalled the transfer of responsibility for the task from the doctor to the nurse. Through our sepsis big room we have recognised that we had to develop electronic processes to serve each of these functions: providing information on the treatment that is required but also triggering that care to occur quickly and effectively.
The big room approach
The big room brings together all the people involved in a patient’s pathway, such as doctors, nurses and pharmacists at the frontline, plus the patients themselves, the software engineers building our electronic patient record system Cerner, information analysts and senior clinicians and managers involved in developing our services. It’s a space where everyone can come and take part in the discussion, and we flatten the hierarchy so everyone takes a turn at leading and facilitating the meeting.
Patient stories are at the centre of this work. Combining stories of sepsis care with data about how effectively we’re treating sepsis enables us to identify a problem we want to improve, create a change to fix it, test the change and use data to see whether the change is an improvement.
Designing an alert system for sepsis
In the sepsis big room, we’ve focused on improving our ability to recognise and treat sepsis quicker and more effectively. We recognised the electronic patient record system has a distinct advantage: the system captures patients’ observations, like pulse rate and blood pressure, as well as laboratory results. If a patient has a certain combination of observations and lab results, that can indicate sepsis. Using that data, the Cerner sepsis alert within the electronic patient record system flags that the patient could have sepsis. The alert prompts a doctor or nurse on the ward to review the patient immediately and, if they have sepsis, to record the diagnosis on the electronic record. This prompts the launch of sepsis ’power plans,’ which detail the investigations and treatments required to treat the patient. The alert and power plans help us ensure the patient gets the right antibiotic treatment as soon as possible.
We piloted the alert on the acute medical unit at St Mary’s Hospital and found plenty of things that we could improve – not just in terms of the technical aspects of the alert but also how a wide range of staff and departments can best communicate with one another. How does the doctor know which nurse will need to administer treatment to the patient? How can we make sure information that has been gathered in the emergency department – where most of the acute medical unit patients start their hospital journey – is communicated efficiently and reliably through our electronic system? How can we make the alert more sensitive and more specific, in order to ensure we capture every patient who may be on the brink of deteriorating? Can we use this system to promote better use of antibiotics? And how can all of the data we collect be used to help wards improve the way they care for people with sepsis?
We’ve been tackling all of these questions in the big room and used them to improve the alert system. We’ve rolled it out in the emergency departments at St Mary’s and Charing Cross hospitals, and launched the alert in our haematology service. We’ve redesigned the way the alert works on our electronic system and we are constantly refining the way we collect and feed back data to facilitate improvements.
The alert has made a significant impact: since its introduction a year ago, the number of patients across our hospitals coded with a diagnosis of sepsis has increased by 85 per cent, from an average of 26 cases per week to 48 cases. Meanwhile, the proportion of patients with a diagnosis of sepsis who die in hospital has dropped by a third during this time. More of our patients are being diagnosed with sepsis, but are surviving sepsis, too.
The work is also encouraging greater staff engagement, particularly amongst junior doctors and nurses. It allows for iterative improvement in response to data and patient and staff voice. Finally, we have demonstrated a new method of designing and building change in the electronic record that moves away from the ‘fire and forget’ approach, ensuring that staff take the right actions for patients at the right time.
Next steps
We’re now working to roll out the sepsis alert across the Trust. We’re looking for ‘sepsis champions’ across the Trust to join our weekly sepsis big room and help us improve the care we offer. We’re also looking for patients and carers who can share their stories about sepsis treatment – what went well, what went wrong, and how they believe we can do better.
The sepsis big room meets every Thursday from 2pm to 3pm in the Acrow boardroom at St Mary’s Hospital. We encourage everyone to join us and help us improve care for people with sepsis, wherever they are in their journey. We hope to see you there.
For more information about the sepsis big room, email Dr Anne Kinderlerer at a.kinderlerer@nhs.net.
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