Frontline Staff are Critical to the Success of Sepsis Care Improvement Efforts

August 25, 2016 by CDC's Safe Healthcare Blog

Martin E. Doerfler MD

Guest Author: Martin E. Doerfler, MD SVP, Clinical Strategy and Development, Associate CMO
Northwell Health

Northwell Health has been focused on improving the care and outcomes of our patients with sepsis since 2008. Michael Dowling, our CEO, noticed that sepsis was the condition most commonly associated with inpatient mortality in our hospital system, so he decided to launch initiatives that have reduced the sepsis mortality rate by ~ 66%.
There are many important components to how we achieved this success. Northwell includes 21 hospitals with 61,000 employees in a community of millions of individuals. As part of the sepsis improvement initiatives, we developed sepsis guidelines, created educational materials, and trained staff in our hospitals. We collected data and set target goals. But, most importantly, we included frontline staff in these initiatives, which is an absolutely critical, yet overlooked, component of sepsis prevention and early recognition initiatives.

In LEAN methodology, the “True Expert” is the person who actually does the work; not the person with the greatest amount of subject knowledge. Frontline staff are critical to identifying and implementing sepsis patient care improvements that will be effective because they genuinely understand what efforts actually work at 2 AM on Wednesday night.

For example, if a patient is suspected to have sepsis, our team works to act fast and start treatment within 90 minutes. For a patient in the emergency department, this means:

Vital signs must be done timely and accurately at triage when an infection is suspected.
The provider confirms the findings and writes the order promptly.
Blood is drawn expeditiously and the sample is transported to the lab without delay.
The lab personnel run the sample without waiting for other specimens.
Results are returned to the primary team quickly so they have the information to guide further decision making.

Every step in this process must be done in a timely manner. We have found that having all members of the patient care team play a role in improvement activities is critical to success that I do not believe can be duplicated any other way.

Together, we can protect more patients from sepsis.

Martin E. Doerfler, MD is SVP, Clinical Strategy and Development, Associate Chief Medical Officer for Northwell Health. He is also Associate Professor of Medicine and Science Education for the Hofstra Northwell Scholl of Medicine. Dr. Doerfler leads the Office of Clinical Transformation and is the Executive Sponsor of Northwell’s system Sepsis initiative which has led to an improvement in Sepsis Mortality rate of > 60% over the past 6 years. He is also a member of the Board of the Rory Staunton Foundation.

August 25, 2016 by CDC's Safe Healthcare Blog