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fluids and antibiotics if there
is any evidence of infection,
and the patient’s vital signs
are monitored continuously.
Everyone in the ED is aware
that with sepsis, as with trauma,
a heart attack or a stroke,
there is a “golden hour” — a
critical period during which the
progression of the illness must
be halted.
Since 2008, the lives of
hundreds of patients like our
hypothetical patient have been
saved. The health system’s
mortality rate for severe sepsis
and septic shock has declined to
35 percent (as of August 2011)
— a significant accomplishment,
certainly. But the real work
is just beginning, according
to Martin Doerfler, MD, the
health system’s vice president of
evidence-based clinical practice
and co-chair of the North
Shore-LIJ Sepsis Task Force,
with John D’Angelo, MD,
director of emergency medicine
at Glen Cove Hospital, and
Darlene Parmentier, RN,
manager for critical care at Glen
Cove Hospital.
“Over the last three years,
we’ve laid the foundation
for fighting sepsis,” said Dr.
Doerfler. “There is no question
that we have made progress.
But now, in collaboration with
the Institute for Healthcare
Improvement [IHI], we are
rolling it out on a grand
scale.” In addition to the sepsis
initiative, the partnership
with IHI has three other
phases: improving the quality
and accessibility of palliative
care, preparing students and
professionals to be outstanding
“improvers,” and improving
the health system’s capacity to
improve. The kick-off event
for the work phase of the
sepsis initiative was a two-day
workshop held the last week
of February at the Swan Club
in Roslyn, and attended by
clinicians and administrators
from the health system and
every hospital.
“In the past we focused on
the intensive care units. More
recently we have focused on
the EDs, where patients are
often at the sicker end of the
sepsis spectrum — low-hanging
fruit,” said Dr. Doerfler.
“Next, we want to move the
focus upstream — to catch
them on the floors and treat
them before they progress
to severe sepsis.” Over the
next four years of the IHI
partnership, Mr. Dowling has
challenged the task force to cut
the health system’s 35 percent
mortality rate in half, which
will put North Shore-LIJ in
the company of the top 10
percent of its peers for severe
sepsis/septic shock mortality.
“I commend emergency
services personnel and
nursing leadership at the
health system and hospital
level for stepping up to the
plate in an exemplary way,”
said Dr. Doerfler. “So far, the
work has fallen on them and
they have embraced it. They
have helped us take many steps
forward. In this next phase,
many additional people in the
health system will be involved,
working with IHI teams on
a weekly basis, at a much
deeper level of engagement
and understanding. We
have some distance yet to
cover, but I believe we have a
reachable goal.”
Jumping for
Good Health
Over the past year, Cohen Children’s
Medical Center (CCMC) and Kohl’s Cares
for Kids have conducted an educational
program with students at Jackson Main
Elementary School in Hempstead. The
program was a health and wellness
initiative aimed at educating students
on proper nutrition, the importance of
exercise and how to stay fit at home.
Teachers worked with a program called
“Activity Works,” which urges youngsters
to perform 12 minutes a day of exercise
in the classroom, and to report what
they’ve learned to their parents and
siblings. Students worked so hard to
meet their exercise goals that CCMC and
Kohl’s decided to surprise them with a
visit and performance from the nationally
recognized jump rope team, Lucie B.
Jump N Fun Rocket Ropers. Afterwards,
students joined in the fun.
The New Standard 23