UCLA HEALTH High Reliability Organization & Sepsis Program UCLA Health Key Findings Of all patient deaths at UCLA, Septic patients account for 25.34%, and Septic Shock pa- tients have an average mortality rate of 40% Septic patients have >300% of dying com- pared to other patients Septic patients generate >1000 excess bed days per year On average 20% of septic patients readmit Septic patients stay 20% longer than other patients Bundle Compliance (CMS SEP-1) RRMC 25% SMMC 48% 27% of clinical surveillance encounters are related to Sepsis and 30% of inital deteriora- tion Greater than 75% of Sepsis patients present in the Emergency Department at SM and 64% at RR 2/5 patients who are diagnosed with severe sepsis or septic shock will die before leaving the hospital A comprehensive sepsis infastructure Santa Monica ED Bundle Compliance im- proved ~25% from 2015-2017 Repeat Lactate compliance increased from 71% at SM and 87% at RR in Jan ‘17 to 100% in March ’17 90% of nurses screen their patients upon admission to the unit UCLA Health Best Practices UCLA’s Sepsis Program comprises a comprehensive infrastructure aligned with “High Reliability” organizational principles. The program uses an interdisciplinary approach to improve overall patient outcomes through sustainable actions. The program uses current education and outreach, care connect improvements, clinical champions, and data analysis to improve overall care of the septic shock patient. The goal of the program is to recognize and treat Severe Sepsis and Septic Shock early and thereby decrease Sepsis related mortality rates and improve patient outcomes across the UCLA Health System. Research Program Integration Joint Commission Sepsis Certified Center Integration of Clincial Documentation Teams into Sepsis Improvement Complete infusion of sepsis language in clinical practice Barriers Alignment with Care Connect/ISS Dedicated resources for data analytics Systematic organizational support Consensus about treatment of septic shock/- severe sepsis treatment among Physician groups Process & Protocols Data Culture Accountability No Sepsis Guidelines Sepsis Screen- ings and Bun- dles Integrated Order Sets and Protocols Backup & Redu- dant Systems No way to measure errors Event Reports & Sepsis Dash- boards Sepsis process and outcome benchmarking Continous Re- al-Time Sepsis Sur- veillance Trial and Error Defining Roles in Sepsis Collective Drive Sepsis Day Preoccupation with Sepsis Failure Individual Au- tonomy Sepsis Safety & Quality Teams Centralized Sepsis Control Organizational Awareness 2018 GOALS 1. Standardize UCLA definition for Sepsis that integrates definitions for Sepsis 2.0, 3.0 and includes SOFA and qSOFA using ICD-10. 2. Develop unit based and service line specific dashboards (Include Time of Presentation). 3. Implement evidence based and highly reliable innovations in Care Connect to support clinical de- cision making. 4. Ensure appropriate resources to support the sepsis program, i.e. Full time sepsis coordinator 5. Improve compliance with CMS (SEP-1) core measure. Track & develop learning system from fallouts 6. Refine emergency response for sepsis, and integrate the surveillance team initatives ie. code sepsis 7. Research and complete a gap analysis on the Joint Commission certified sepsis center accreditation. Areas of Innovations and Future Opportunities: Sepsis Continuum of Care Implemented In Progress Future Opportunities EMS & Community Floor Sepsis RN (SM) & STAR (RR) Nurse Driven Protocol Nurse Driven Protocol Emergency Department SM RN BPA RRT RN Screening Tool Sepsis Audit Graph RN Screening Tool Dynamic RN tool Code Sepsis RN Screening Tool Dynamic RN tool MD BPA MD BPA ED to IP SBAR MD Orderset & Panels MD Orderset & Panels ED to IP SBAR ICU MD Ordersets Repeat Lactate MD BPA Alerts for Palliative Care RN BPA EMS Screening EMS to ED Standard 2012 Simulation Center Collaboration (MDs/RNs) Care Connect go-live Adult MD order set LIVE in Care Connect Nursing Protocol developed System level nursing champions MD order sets developed Sepsis Website Launched Adult sepsis screening tool launched Second Annual Sepsis Day QMS Manager hired for sepsis Sepsis Project Manager hired SRRMC Sepsis Coordinator hired RN mandatory education ( yearly) ED sepsis screening tool launched (CView) Adult Sepsis MD order set developed Sepsis champions model defined QMP database for sepsis cases Sepsis Lab panel created First Annual Sepsis Day Dr. Dan Uslan – named MD Champion 2013 2014 2015 2016 2017 New Definitions: Sepsis 3.0/SOFA ProCESS, ARISE, ProMISe Studies 2001 2003 2008 Early-Goal Directed Therapy Surviving Sepsis Campaign National Quality Forum Affordable Care Act Innovation: BPA pilot launched and ended Innovation: ED code sepsis page launched Innovation:MEWS - RRMC pilot 3rd Annual Sepsis Day ProCESS, ARISE, ProMISe Studies SEP-1 (CMS) Follow-up/MD fallout letter process update Clinical Triggers pilot SMH Dr. Steven Chang – interim Sepsis MD Dr. Tischa Wong – Sepsis Physician champion Sepsis module for all 1st year residents 4th Annual Sepsis Day Innovation: Parahealth Pilot RRMC Clinical Surveillance Team – pilot Dr. Russ Kerbel – Sepsis Physician Champion RRMC Clinical Surveillance Team –LIVE 24/7 RRMC Revised RRT team – LIVE 3/2017 SMH Sepsis RN hired New Website launched Innovation: Repeat lactate available Innovation: Sepsis IV fluid bolus order Innovation: Code Sepsis Inpatient (System) Value-Based Purchasing ? Hospital Compare 2018 National UCLA Long Term Goals UCLA Health Sepsis Program