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Decisio White Paper

POPULATION HEALTH The

POPULATION HEALTH The IHI Triple Aim objectives seek to improve the health of population. Decisio Health and its hospital partners have greatly impacted the health and well-being of the patients they serve by continuously monitoring inpatients for subtle changes in their health status. The academic medical center launched DECISIOInsight ® in the surgical ICU beginning in June 2016. It was integrated with their clinical information system and continuously displayed vitals, lab data, and a Foley and Renal Bundles of Care module on a clinical dashboard. This was displayed on a dedicated 42” monitor located at the bedside. One year later, a sepsis screening bundle was added to the clinical dashboard. The dashboard displayed the things it was continuously monitoring, such as heart rate, body temperature, respiration rate, various labs required by the unit, and trending data. The sepsis bundle indicator would turn “red” if the score exceeded a pre-determined threshold. This visual alert signaled a clinician to assess the patient for sepsis and that early intervention may be warranted. If you are a patient in a hospital bed unknowingly developing sepsis, your best chances for survival are linked to early detection and evidence-based intervention 6 . We know that the earlier sepsis is detected, the earlier a clinician can initiate sepsis care protocols, known as “the sepsis bundle”. Early intervention can prevent sepsis from turning into severe sepsis and then septic shock. Early intervention is what saves lives. One afternoon right before the winter holidays, a husband and his two teenaged children were visiting his wife who was recovering from a minor, routine surgical procedure in the hospital. They were so happy to see her that they didn’t notice her very mild, labored breathing. Perhaps they thought she was just getting excited listening to the kids talk about all of the plans for the upcoming holiday break. After all, planning a family vacation at the holidays and preparing for family and friends right after surgery would make anyone a little tired! A short while later, the registered nurse entered the room and performed an assessment: Mom was using oxygen by nasal cannula (common in the post-op period), she had a respiration rate of 21 (the normal limit is 20), and a temperature of 100.1 (the normal limit is 98.6). These very small aberrations may have been judged as insignificant to any one nurse at any one particular time, but taken together, they were noted by DECISIOInsight ® and triggered a sepsis alert. The nurse drew a lactate lab that was greater than 2 (normal is less than 1), which prompted her to call a “Code Sepsis”. The nurse’s quick action brought a physician to the March 2018 DECISIO | decisiohealth.com 6

scene, who diagnosed sepsis and started Early Goal Directed Therapy (EGDT) within an hour of the start of her symptoms. Because of the actions of this high-performing team and the early intervention this patient received, this 45-year Mom stayed on the floor of the hospital, avoided transfer to the ICU, and went home healthy to enjoy the holidays, and many more days, with her growing family. What’s in a sepsis bundle? The sepsis bundle is completed within 3 hours for patients presenting with sepsis 7 : • Measure serum lactate • Obtain blood cultures • Administer broad-spectrum antibiotics • Treat hypotension/elevated lactate with fluids These things are added to the sepsis resuscitation bundle within 6 hours for patients presenting with severe sepsis or septic shock 8 : • Maintain mean arterial pressure >65 mmHg with vasopressors • Achieve a central venous pressure of >8 mmHg • Achieve central venous oxygen saturation >70% For ongoing sepsis management within 24 hours 7 : • Administer low-dose steroids • Administer recombinant human activated protein C • Maintain glucose control lower than limit of normal • Maintain a median inspiratory plateau pressure

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