335
8 54 13.7% 3751 1023.3% 15.8%10.1%57 12 15.4% 52
102 7 30% 9 8
0.1372549 5 192 0.1578947 5% 57% 0.1538462
48 25% 20% % of trigger sco
275 3.125
19 0.6732673
118 35% 14.5% 13.7%
L E V E R A G I N G T E C H N O L10% OGY
Lactate < 2 Lactate 2-‐14 Lactate >4
0.0891089
69 25 6
0%
4 6 8 Triggers alert clinicians to patient decline,2 Figure 1 positively change trajectory of care % of # of Trend in Early Warning System Scores Prior to RRT
% of trigger scores >= 4
triggers ≥ n (Total # triggers ≥ 6 40% Hours Concurrent 4 earlyTrigger) 4 35.1% warning triggers that predict a patient’s development of risk factors for patients at risk for 2 of sepsis, 35.1% 20 ICU 0.3508772 risk oversedation or clinical deterioration onlineP25 documentation of a tsedation score Sepsis A57 dvisory Rapid Trigger Response TTransfer eam CLactate all are giving Measured LA >4oversedation; Antibiotics Abx rovided <=3 Median ime Abx to aCbx hange 4 22.0% 59 13 0.220339 clinicians the opportunity to modify and implementation for3.9 early detection5 of 58 45 13 medications 8 and increase 20 2 26 of an algorithm 10 30% 6 14.5% 912 decline 0.1451613 nursing oversight to62 prevent further and sepsis,0 with an advisory alert and evidence-based advisory 74 48 7 mitigate 16 23 10 3.3 2 22.0% 8 13.7% 51 7 0.1372549 patient 50 harm. quickset in care. 41 9 7 12 1 orders to 24reduce variation 15 4.4 6 10 15.8% 57 914 0.1578947 20% 69 68 51 12 19 2 32 9 4 5 14.5% 13.7% The trigger database52 — which captures information already6 in Christiana Care 12 Value Institute4 researchers 12 15.4% 86 0.1538462 25 17 3 0 3.5will continue 1 the electronic medical record, including vital signs and lab test to analyze the database to identify potential harm to our 275 335 54 37 102 5 192 48 3.9 19 10% results — identifies patients at greatest risk for harm. Research patients. • 3.125 23.3% 10.1% 30% 5% 57% 25% 0.6732673 by the Christiana Care Value Institute indicates that a patient’s Lactate < 2 Lactate 2 – 4 Lactate >4 vital signs begin to deteriorate four to six hours prior to the 0% Outcome of Sepsis Triggers time of a Rapid Response Team call. Early warning system 2 4 6 8 triggers reduce the need for frontlineLactate staff to<call 400 30% 2 a Code Blue 69 or rapid response team. 60% 0.0891089 Lactate 2-‐14 25 57% 25% Lactate > 4 6 In a sepsis pilot conducted on four medical-surgical patient300 50% care units, trigger advisories identified 335 patients at risk for 335 20% 40% sepsis in the first six months. Based on assessment, the care <=3 Median time Abx to aCbx hange Sepsis Advisory Rapid Trigger Response ICU TTransfer eam CLactate all Measured LA >4 Antibiotics PAbx rovided 200 15% team ordered level 58 45lactate 30% 13measures for8 30 percent 20of those30% 2 26 10 3.9 5 6 patients. Of them, 57 percent required antibiotics. Median 74 48 12 7 192 16 0 23 10 3.3 2 10% time to antibiotic administration was less than four hours. 20% 50 41 9 7 12 1 24 15 4.4 25 6 100 Only 10 percent of triggered to an 2 68 51 102 14 patients12required transfer 19 32 9 4 5 5% 10% intensive care unit, suggesting that triggered staff interventions 25 17 6 3 6 0 12 4 3.5 1 may have 335 positively changed of care. 0 0% 0% 5 275 54 the trajectory 37 102 192 48 3.9 19
2 2 2 15.8% 2 1 11 35%
10
Sepsis Trigger
sis Advisory Trigger
400
3.9
Lactate Measured Antibiotics Provided 3.125 23.3% database 10.1% 30% 5% Milestones for the trigger include enhanced Number of Patients with Trigger Percent of Triggers timeliness of vital sign documentation, standardization of abnormal vital sign parameters requiring nurse notification,
Lactate < 2 Lactate 2-‐14 Lactate >4
0.0891089
Sepsis ICU 25% Rapid Response 0.6732673 Advisory Team Call Transfer
57%
Number of Patients with Trigger
69 25 6
Percent of Triggers
Lactate < 2
Lactate 2 – 4
Lactate >4
Lactate Level with Sepsis Trigger 400
Care Processes Following SepsisTTrigger Sepsis rigger 400
300
69
29 22 26 29 12 118 35%
57%
60% 25%
6
300
50%
335
30%
20% 40%
30%
200
192 100
200
30%
100
10%
0
Lactate Measured
Number of Patients with Trigger
Antibiotics Provided
0%
Number of Patients with Trigger
Sepsis Trigger
52 | C hri sti ana Care Hea l th S ys tem
5%
Sepsis Rapid Response ICU Call Transfer Lactate < 2 Advisory Lactate 2 –Team 4 Lactate >4
Percent of Triggers
400
57%
69
0
0%
Sepsis Advisory Trigger
15% 10%
20%
102
25
Percent of Triggers
30%
60% 25%