Dr. Penny Cooper, DHSc, is a data scientist at Augusta Health
Augusta Health is a community hospital nestled in Virginia’s beautiful Shenandoah Valley focused on improving the health and well-being of our community. The statewide sepsis mortality rate in Virginia is 12.7%, while at Augusta Health it is 4.76%. We have been able to achieve a significantly lower sepsis mortality rate by employing the power of artificial intelligence (AI) and communication technology. So far, we have saved nearly 300 lives that could have been lost to sepsis.
Mortality from sepsis increases by as much as 8% for every hour that treatment is delayed. Our nurses are highly trained and are skilled at detecting early symptoms of sepsis based on standard indicators. They are also very busy. Aware of how many patients our nurses care for and the many tasks nurses juggle at once, our leadership team wanted to provide our nurses with additional support. Among the resources provided was a program to identify symptoms of sepsis sooner.
We formed a Sepsis Team and Taskforce in 2016 to take advantage of AI and communication capabilities and give our nurses an extra set of eyes to automatically review patient data and alert them as soon as a patient shows signs of being septic. Our goal was to detect and treat sepsis as early as possible and save lives.
Automated Process for Sepsis Risk Detection and Alerts
We began by using the four traditional criteria to identify sepsis – a temperature greater than 38°C, heart rate greater than 90, respiratory rate greater than 20, and an abnormal white blood cell count. In addition, we monitored mean arterial pressure and shock index. Our Sepsis Team and Taskforce then began a retrospective study of the data to determine which variables had the highest correlation to Sepsis.
We used the results of that study as a benchmark for developing an automated process that analyzes and compiles real-time data from medical systems each hour and assigns each patient a score. If the score is above a specific threshold, a sepsis alert is sent automatically to team members caring for that patient. Team members receive the alert with contextual information on their mobile communication device, which might be a hands-free Vocera Badge or a smartphone running a Vocera app.
System Interoperability Including Real-Time Communication
The automated process involves interoperability among three systems:
Our electronic medical record (EMR), MEDITECH
Our predictive analytics tool, which scours critical data in a patient’s record
The Vocera clinical workflow and communication system
We considered other sepsis alert tools that flagged potential sepsis cases within patients’ EMRs. However, those tools provide clinicians with sepsis alert flags only when they open the patient’s medical record. By contrast, the system we built alerts the care team immediately on their Vocera Badge or smartphone, without any manual intervention. Sepsis alerts are automatically sent to the right care team to initiate care quickly when early signs of infection are identified.
System interoperability has been key to ensuring the right data with situational information gets to the right clinicians at the right time. Upon receiving an alert, the assigned staff member immediately screens the patient for sepsis. If sepsis is identified, they begin early intervention.
Saving Time, Saving Lives
In the United States, more than 1.7 million people develop sepsis each year, and approximately 270,000 of them die. To decrease mortality rates and increase the likelihood of reversing the damaging outcomes of sepsis, early detection is critical. Hundreds of lives that could have been lost to sepsis have been saved because of our Early Sepsis Alert System; between April 2016 and March 2019, we were able to save 282 lives.
The work done by our teams at Augusta Health to reduce mortality rates from sepsis has been a collaborative effort. Health Quality Innovators (HQI) named our hospital the Health Quality Innovator for Virginia in the category of Data-driven Care in 2018. U.S. News & World Report recognized Augusta Health as a Best Hospital in the Shenandoah Valley for 2019-20.
We are very proud of these honors and are happy to have the opportunity to share our work with other facilities around the state so more lives can be saved.