patient safety quality healthcare

PSQH Applies for BPA Worldwide Business Publication Membership

Danvers, MA February 2016 – Patient Safety & Quality Healthcare ( has applied for business publication membership in BPA Worldwide. The magazine is published by BLR (Danvers, MA).

BPA Worldwide will track circulation for Patient Safety & Quality Healthcare (PSQH) based on business/distribution, demographics and geographic coverage. The magazine will have 12 months to complete its initial circulation audit.

“We are pleased that Patient Safety & Quality Healthcare has applied for membership in BPA Worldwide,” said BPA President and CEO Glenn Hansen. “We applaud the publisher for providing advertisers and prospects with the solid assurance of an independent circulation audit conducted according to our world-respected, uncompromising standards. With a BPA audit, media buyers can be confident that circulation claims are accurate, and that they have the verified data that they need to assess a publication’s effectiveness in serving its market.”

Patient Safety & Quality Healthcare is known throughout the industry for its in-depth frontline reporting of successful patient safety and healthcare improvement programs,” said Elizabeth Petersen, Executive Vice President of BLR’s healthcare division. “We’re pleased to continue to serve this important market.”

Patient Safety & Quality Healthcare brings patient safety and quality improvement stakeholders together. Subscribers include patient safety officers, quality improvement executives, risk managers, infection control managers, executive nurses, pharmacy directors, and other clinical executives. Subscribers are encouraged and challenged to break free of their established work silos to look for new solutions and performance breakthroughs. Each issue of PSQH includes industry news, topical columns and departments, case studies of successful implementation of patient safety/quality improvement programs, and information from prominent industry associations and sponsoring organizations. The editorial content is written by industry experts and practitioners, and carefully edited by the PSQH editorial team.

About BPA Worldwide. BPA Worldwide is the business of providing assurance. For 80+ years as a not-for-profit assurance service provider, BPAWW was originally created by advertisers, advertising agencies and the media industry to audit audience claims used in the buying and selling of advertising. Today, in addition to auditing audience claims, through its iCompli service, BPAWW verifies compliance to defined government, industry, and organizational standards as well as adherence to privacy, data protection and sustainability guidelines and best practices. With more than 3,600 clients in over 20 countries, BPAWW is a trusted resource for compliance and assessment services. Its latest offering, Ad iCompli, measures and scores online ad campaign performance for business and consumer marketers.

For more information on BPAWW and its services, please visit

About BLR. BLR®—Business & Legal Resources helps U.S. businesses simplify compliance with state and federal legal requirements and helps them become more successful. They accomplish this by offering authoritative content and practical, easy-to-use tools. Through their expert in-house editors and exclusive attorney network, they provide the most comprehensive, reliable state-specific information available—and do it in all 50 states. Their award-winning information products—including training programs, events, Web portals, reports, and subscription services—give businesses of all sizes and industries the best tools available at affordable prices.

Patient Safety News Roundup

CMS penalizes 758 hospitals for patient safety infractions

The CMS has fined 758 hospitals across the country for high rates of patient safety incidents including infections, sepsis, and hip fractures.

More than half of the hospitals that were fined in 2015 also received fines the previous year, according to Kaiser Health News. Hospitals will pay a total of $364 million in penalties.

The federal penalties have been a divisive issue, splitting patient safety advocates that argue the fines are not large enough to make sustainable gains in preventing patient harm, against providers, who say hospitals are unfairly punished for falling below certain thresholds, even when they have made significant strides in reducing adverse events.

One thing is for certain: Medicare fines don't discriminate based on reputation. Stanford Health Care, Denver Health Medical Center, Mount Sinai Hospital Medical Center, and Mayo Clinic hospitals were among the providers fined this year.

Continue reading this article on the Patient Safety Monitorwebsite. Subscribers have free access to this article in the February issue.

New Tool Simplifies the Process of Patient Safety Improvement

A new tool offers a straightforward approach to improvement

A new tool endorsed by the National Patient Safety Foundation aims to streamline patient safety and quality improvement efforts using a simple, evidence-based model.

"The Healthcare Adventures Graphic Gameplan for Patient Safety," released in October 2015, offers a standardized approach both leaders and clinicians can use to address gaps in patient safety. A multidisciplinary group that partnered patient safety experts with human development and organizational behavior experts created the tool and released it for free with the hope that some hospitals would be able to apply the same principles to initiatives within their facility.

Patient Safety Monitor Journal spoke with one of the guide's authors, Jay Vogt, an organizational and human development consultant and founder of Peoplesworth in Concord, Massachusetts, about the tool and how hospitals can use it to improve patient safety interventions and address cultural barriers.

Continue reading this articleon the Patient Safety Monitorwebsite. Subscribers have free access to this article in the February issue.

Study: Poor Communication Leads to Malpractice, Death

Poor communication in healthcare has tangible, measurable effects. A new study released by CRICO Strategies found that communications failures were a factor in 30% of malpractice cases between 2009 to 2013, including 1,744 deaths. The reports estimate that both the deaths and $1.7 billion in malpractice costs could have been avoided with better communication between patients and physicians. 

Read more...

CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs

Just over a year after President Barack Obama issued an executive order calling for federal agencies to combat antibiotic resistance, The Joint Commission has released proposed standards that would require a broad range of healthcare providers to implement a structured, evidence-based antimicrobial stewardship program.

Read more...

JAMA: Nurses Key to Surviving Surgery

A study released in The Journal of the American Medical Association has found that surgical patients in hospitals with better nursing environments receive better care without drastically increasing costs. Researchers found the rate of 30-day mortality rates for postoperative patients was 4.8% at hospitals with more than 1.5 nurses per bed (NPB), while facilities with less than one NPB had mortality rates of 5.8%. The difference was most noticeable for patients in the highest risk quintile, with a mortality rate of 17.2% at magnet hospitals compared to 19.9% at control hospitals.

 “It wasn’t just the number of nurses that made the difference. Magnet status hospitals recognized for having excellent nursing programs and cultures do better,” said study author Linda Aiken, PhD, RN, in a release.

While there are numerous studies showing the benefits of a large nursing staff, the costs of hiring new staff has been an impediment for many facilities. Despite this, it was shown that better staffed hospitals actually paid less ($163) overall per patient than understaffed hospitals.

 “A surprising finding was that better nurse staffing throughout the hospital does not have to be more costly,” Aiken said. “Indeed, we found that magnet hospitals achieved lower mortality at the same or lower costs by admitting 40% fewer patients to intensive care units and shortening length of hospital stay.”

Nominations Open for Sherman Award for Excellence in Patient Engagement, an online community dedicated to sharing best practices in patient and family engagement, is now accepting nominations for the 2016 John Q. Sherman Award for Excellence in Patient Engagement.

Established in 2014, the Sherman Award is dedicated to recognizing innovative work that has resulted in better, safer care and improved outcomes by engaging patients and families in their care. The award—a partnership between, the National Patient Safety Foundation’s (NPSF) Lucian Leape Institute, and Standard Register Healthcare—will be conferred at NPSF’s 18th annual Patient Safety Congress in Scottsdale, Arizona, on May 24, 2016. The winner will receive an all-expenses-paid trip to Scottsdale for the congress.

“Increasing attention on engaging patients and their personal support networks signals a true shift in healthcare,” said Mark O’Leary, chair of’s advisory board and president of Standard Register Healthcare. “Each project represents an organization’s commitment to creating deep and lasting relationships by engaging and activating patients and families across the continuum of care. We hope showcasing these outstanding projects and caregivers will inspire more patient and family-centered practices.”

Named for John Q. Sherman (1882-1939), founder of Standard Register and philanthropist, the award is given to a program focused on enhancing patient and family engagement. Programs will be judged on patient and family involvement in project design and implementation, measurable results, sustainability, and reproducibility of the project.

“Patient and family engagement is essential to the delivery of safe and appropriate health care,” said Tejal K. Gandhi, MD, MPH, CPPS, president and CEO of NPSF and president of the NPSF Lucian Leape Institute. “We are pleased to collaborate with to recognize those who have put successful practices into place to partner with patients, and this award is a wonderful way to share what they have learned.”

Nominations will be accepted through March 11. Work must have occurred between January 1, 2014, and January 31, 2016. The official nomination form and full details about criteria for the John Q. Sherman Award are available at

Olympus Recalls Duodenoscopes, FDA Approves New Model

Olympus Corp., the largest seller of duodenoscopes in the U.S., last week recalled all of its TJF-Q180V model scopes. The move came just one day after a Senate committee report linked Olympus products to 142 antibiotic-resistant infection (ARI) cases.

Duodenoscopes are flexible cameras inserted into a patient’s mouth or digestive tract to diagnose a number of cancers and are used in over 700,000 procedures annually. Recent investigations found a flaw in the scope’s design made it nearly impossible to fully disinfect—exposing patients to ARIs and resulting in 25 outbreaks in four countries over the last three years. Last year, 141 patients in Los Angeles were infected and three died from ARIs attributed to dirty scopes.

Olympus voluntarily issued the recall after the Food and Drug Administration (FDA) cleared the company’s new safety modifications to the existing model. Olympus will replace the elevator channel sealing mechanism at the tip of the scope with a new mechanism that should reduce the risk of fluid leakage in the channel, according to the report.

Olympus will begin replacing the scopes next month. There are approximately 4,400 scopes currently in use and Olympus hopes to have them all replaced or modified by August 2016. Until the scopes are replaced, healthcare facilities may continue using the unmodified TJF-Q180V models, but are urged to meticulously follow the manufacturer’s reprocessing instructions.

Editor’s note: This article was adapted from Accreditation & Quality Advisor

FDA Releases Cybersecurity Recommendations for Medical Device Manufacturers

Cybersecurity threats to medical devices are a growing concern. The FDA took a proactive step last week and released draft guidance last week encouraging medical device manufacturers to address certain cybersecurity risks to keep patients safe.

Manufacturers should look beyond the initial security measures implemented in a medical device and consider additional safety measures throughout a particular device’s whole lifecycle, according to the report.

“All medical devices that use software and are connected to hospital and healthcare organizations’ networks have vulnerabilities—some we can proactively protect against, while others require vigilant monitoring and timely remediation,” said Suzanne Schwartz, MD, MBA, associate director for science and strategic partnerships and acting director of emergency preparedness/operations and medical countermeasures in the FDA’s Center for Devices and Radiological Health, in a press release.

The guidance stresses the need for proactively planning and assessing cybersecurity vulnerabilities, information sharing between the public and manufacturers, as well as creating a cybersecurity risk management program that includes:

  • Applying the 2014 NIST voluntary Framework for Improving Critical Infrastructure Cybersecurity
  • Monitoring cybersecurity information sources to identify any vulnerabilities
  • Understanding, assessing, and detecting the presence of possible vulnerability
  • Defining essential clinical performance to identify, protect, respond and recover from a cybersecurity threat
  • Adopting a threat disclosure policy and practice
  • Implementing measures that identify cybersecurity risk early and before an incident occurs

C.diff Infection Raises Hospital Costs by 40% per Case

By Alexandra Pecci, for HealthLeaders Media

Treating Clostridium difficile adds about $7,285 in hospital costs per patient, not including readmissions, research finds.

It can be difficult to quantify the exact economic burden of C. diff on hospitals and the health system as a whole. But a recent study puts a dollar amount on the cost of C. diff, that number is not only big, but also likely underestimated.

Published in the November issue of the American Journal of Infection Control, the study found that C. diff-associated diarrhea (CDAD) increases hospital costs by 40% per case and puts those infected at high risk for longer hospital stays and readmissions.

Read more...

FDA validates revised reprocessing instructions for Model ED-530XT duodenoscopes

FUJIFILM Medical Systems issued revised reprocessing instructions late last month for Model ED-530XT duodenoscopes, according to a safety communication issued by the FDA. The instructions require exacting pre-cleaning, manual cleaning, and high-level disinfection procedures.

While these revised reprocessing instructions are for Model ED-530XT duodenoscopes, the FDA is encouraging healthcare facilities that use Fuji’s 250 and 450 duodenoscope models, to use the revised reprocessing instructions until the revised instructions for those models are final.

Key changes to the reprocessing procedure for Fuji’s ED-530EXT duodenoscope:

  • Pre-cleaning
    • During immersion of the scope tip in detergent solution, move the forceps elevator back and forth and aspirate detergent solution while the forceps is raised and while lowered.
  • Manual cleaning
    • Additional brushing of the distal tip, forceps elevator and elevator recess first using the existing Fujifilm valve cylinder cleaning brush (Model WB11002FW2) and then using the new disposable (Model WB1318DE) cleaning brush.
    • Additional flushing of detergent and rinse water onto the forceps elevator/recess while the elevator is both raised and lowered.
    • Additional flushing steps and increased channel flushing volumes of detergent and rinse water
  • Manual high-level disinfection
    • Additional flushing of disinfectant and rinse water onto the forceps elevator/recess while the elevator is both raised and lowered. Additional raising and lowering of the elevator while immersed in disinfectant solution and rinse water.
    • Additional flushing steps and increased flushing volumes of disinfectant and rinse water through the duodenoscope’s internal channels.


    In October, the FDA ordered the top three manufacturers of duodenoscopes, Olympus America, Inc., Fujifilm Medical Systems, USA, Inc., and Hoya Corp. to submit plans outlining how they were going to conduct studies to understand how the duodenoscopes are being reprocessed in healthcare settings.

    For more information visit the FDA website.

Study: Discharge notes are often written grades above patient reading levels

A study published in The American Journal of Surgery found that low literacy rates can drive up the number of hospital readmissions. Of the 497 patients studied, researchers found that only 24% had the reading skills necessary to understand their discharge instructions, with 65% reading a lower grade level than what their notes were written in.

“Even if patients believe they understand what occurred during their hospitalization and the instructions they are to follow upon dismissal, they can become confused after they leave the hospital environment as their memory can be clouded by medications they were administered, the stress of hospitalization, and, particularly, within our patient population, traumatic brain injuries such as concussions,” senior study author Martin Zielinski, MD, told Reuters.

The study also found that 65% of 30-day readmissions were for patients who didn’t have the literacy skills to understand their discharge notes. Researchers recommend writing dismissal notes at a sixth-grade level to ensure patient comprehension.

Massachusetts medical board proposes rules on simultaneous surgeries

Surgeons in the state of Massachusetts will have to document each time they enter and leave the operating room according to a new regulation approved by the Massachusetts Board of Registration in Medicine, according to a recent report in The Boston Globe.

Patients rarely know if they are sharing their surgeon with another patient, and the lack of documentation about the surgeon’s whereabouts during a procedure leaves some wondering if their doctor actually performed the entire procedure, according to the report.

Additionally, the primary surgeon will need to identify the backup doctor in the event the primary surgeon needs to leave the operating room during the procedure.

Other rules approved by the board last week include:

  • Doctors will be required to report other physicians who are impaired by alcohol or drugs while on duty
  • Online physician profiles have been expanded to include out-of-state malpractice judgments and settlements involving Massachusetts doctors

The approved rules need approval by various state agencies by the end of March before they can go into effect.

The Hidden Patient Experience

Alexandra  Wilson Pecci, for HealthLeaders Media

How well-meaning and clinically important actions can make or break the patient experience, and how leaders at Cleveland Clinic and Mount Sinai Health System are refocusing efforts.

During her hospital's monthly executive leadership rounds, Cleveland Clinic's executive chief nursing officer, K. Kelly Hancock, MSN, RN, NE-BC, met a patient who didn't seem quite happy, despite his insistence that everything was OK.

"We could just tell that he was a bit hesitant in his answers," Hancock says. So before she and her fellow executives left him, they probed a little more, asking "Are you sure there's nothing else we could to make your experience better?"

Actually, something was bothering him. Someone had come in to change his gown, and instead of addressing him by name, such as Mr. Smith, they called him "honey" and "sweetie."

"For him, he was offended," Hancock says.

It may have seemed like a small thing, but it really rubbed him the wrong way, and totally colored his experience as a patient. It was clear that it had been bothering him for quite some time.

"You've really got to dig when you're with the patients and families," Hancock says. "What's important to that patient [is something] you may miss."

Clinicians might check off all of the important clinical boxes when caring for a patient, but it's often the small--perhaps nearly imperceptible--nonclinical elements of a hospital stay that most affect whether a patient has a good experience.

"I think that patients come to us expecting to get really good clinical care," agrees Sandra Myerson, MBA, MS, BSN, RN, senior vice president and chief patient experience officer at New York's Mount Sinai Health System.

With all the effort, money, and attention that's currently being paid to the patient experience, it's important for clinicians to understand how to get to the real heart of how a patient is feeling, and to do it in real-time.

Digging In

Beginning this year, Cleveland Clinic will be starting a program in which providers, such as nurses and physicians, will actually shadow patients during their inpatient stay or outpatient visit to better understand "what their experience is through their lens." Hancock says she's "really excited" about the program and can't wait to start it, adding that they think that "it's important enough that it's clearly worth the investment to take those caregivers offline."

Shadowing could also help clinicians develop the empathy they need to really understand what patients are going through, and therefore, what they care about. Hancock says compassionate care is about being present, empathetic, and listening for key words that a patient uses that might clue clinicians into their emotions, and ultimately, their experience.

Use the right language

Hancock says it's important to meet patients where they are, and the shadowing project will very literally do that. By asking something as simple as "What's important to you during this stay?" clinicians might find out that the patient really wants his hair washed or face to be shaved. They're small things that can go a long way in providing dignity and comfort, but that may not be "important" clinically.

"We have to pay attention to those things that are concerning to the patient that we might not even think they should be concerned about," Myerson says. "We tend to be really task oriented."

Hancock says providing a template for talking about these nonclinical topics can help staff drill down into what's really important or worrying to the patient. In addition, engaging in role-playing exercises can help staff ensure that such conversations with patients happen naturally and without sounding scripted.

Myerson adds that training managers and other clinicians to ask certain open-ended questions, rather than yes-or-no questions, can elicit better responses. For instance, clinicians might ask "How did you sleep?" or "What got in the way of you sleeping well?" instead of "Did you sleep well?"

Another question that could be useful, especially if a patient is suffering, is "What's the worst part of this for you?" according to a new essay in JAMA. Asking such a question and "turning toward" suffering, the authors write, helps not only with the patient experience in the moment, but with overall, long-term healing in a way that straightforward diagnosis and treatment may not. It acknowledges that patients are whole human beings. It's also important to remember that clinicians are whole humans, too, and that these non-clinically focused interactions doesn't always come naturally. That's why they need training.

"We're spending a lot of time and effort around coaching people to be really effective communicators because it's not something that we learned in school," Myerson echoes. "It's about the human experience."

Be visible and open

Myerson says patients aren't always comfortable expressing their concerns during their hospital stay, especially if they're unhappy with a particular clinician. Patients may also not know who to complain to in the first place. That's why nurse managers have to be visible and available to patients.

"What we like to do is have the nurse manger round on every patient every day. It is a really great way for the patient know who's in charge of the unit," she says. "At the end of the day the nurse manager is really the CEO for their unit."

Nurse managers at Mt. Sinai also hand out postcards with their name, photo, and contact information—in English on one side, and Spanish on the other—so patients have it handy if they need to get in touch. Nurse managers at Cleveland Clinic also round on new patients and distribute business cards.

"If I know who's in charge I can go right to the boss," Myerson says.

But it's not only the boss who has a role to play in listening to the patient. For instance, Myerson says some of their housekeepers have a great, natural ability to interact and connect with patients, and sometimes patients will confide things in them. When that happens, they're instructed to tell either the charge nurse, nurse manager, or their own supervisor.

In fact, everyone on the nonclinical teams receive education about making eye contact with patients, smiling, and introducing themselves. Myerson adds that building services team members have huddles before each shift, and "they talk about patient experience almost every single huddle."

"Everybody has a role in the patient experience," Myerson says.

Editor's Note: This article initially appeared in HealthLeaders on January 6, 2016.



Process Improvements in the ED increase sepsis bundle compliance, reduce mortality

By improving compliance with the sepsis three-hour bundle, Dartmouth-Hitchcock Medical Center reduced patient mortality by 50% in just 90 days

Effectively treating any infection requires a certain measure of early identification and rapid response. Infections, by their nature, worsen over time, so hospitals with successful care processes that rapidly identify and treat infections often see the most success.

Identifying and appropriately treating a patient with sepsis, however, takes that response to a whole new level. Research shows that early identification and treatment of sepsis significantly reduces mortality. In a 2011 presentation at the Society of Critical Care Medicine 40th Critical Care Congress, researchers showed an 88% increase in mortality in patients who received antibiotics six hours after arrival, compared with those who received antibiotics within two hours.

Furthermore, sepsis has become more prevalent in healthcare over the past decade. According to statistics released by the National Center for Health Statistics in 2011, hospitalization rates for septicemia or sepsis more than doubled from 2000 to 2008. Seventeen percent of hospitalizations related to sepsis ended in death, compared to 2% of all other hospitalizations. In 2011, sepsis was identified as the most expensive condition treated in hospitals.

Despite the severity of the infection, hospitals still struggle with management and prevention, particularly in the ED where patients are often admitted with symptoms that aren't particularly unique, including fever, rapid breathing and heart rate, chills, and disorientation. This makes sepsis difficult to identify in the early stages.

The reason sepsis is still so prevalent and dangerous is not a lack of best practices; the Surviving Sepsis Campaign was created in 2002 and guidelines have been in place for a decade. But sepsis continues to plague healthcare because of an inability to manage the process of applying those best practices consistently and in a timely manner, says Megan Zweig, senior consultant on research and insights at The Advisory Board Company, headquartered in Washington D.C.

"The issue with sepsis isn't that clinicians and physicians don't know how to treat it," she says. "They know how to treat it. The Surviving Sepsis Campaign guidelines have a lot of underlying literature proving that if followed correctly, they reduce mortality, and yet we still see tremendous figures on the number of people that are dying in this country from sepsis."

But some hospitals are finding that focusing on the lean principles of process improvement offer the most effective way to quickly implement sepsis treatment. In December, Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire announced that it has reduced patient mortality by more than 50% by achieving 80% compliance with the three-hour sepsis bundle, and they did it within 90 days.

The hospital achieved these impressive reductions by taking a very "granular look at every step of the process," according to Andreas H. Taenzer, MS, MD, an anesthesiologist at Dartmouth-Hitchcock who led the intervention.

Taenzer says even when they looked around at other high-performing hospitals, their compliance rates with the bundle hovered around 25% to 30%. The trick was to bring together a variety of clinicians from all parts of the hospital to coordinate processes necessary to improve the response time to sepsis patients.

"The three-hour bundle doesn't sound very difficult, but the actual compliance is very low," he says. "The big picture was we know what to do, it just wasn't clear on how to do it."

Corralling all the moving parts

One of the primary reasons that hospitals struggle to adhere with sepsis identification and treatment best practices is because the guidelines involve many different units working in unison. Nurses screen patients in the ED, physicians order tests from the lab, which dictates if and when antibiotics are ordered from the pharmacy.

"I think it's the complexity of the execution and how many people are involved that make it incredibly difficult to translate what we know works into consistent practice," Zweig says.

Starting in January 2014, Taenzer says his team brought in representatives from all sectors of the hospital?ED nurses and physicians, laboratory technicians, and pharmacists?and dissected the entire three-hour bundle from top to bottom.

During each step of the way the multidisciplinary group discussed problems and obstacles that would impact any one of those departments during any stage of the process.

For example, one of the keys to identifying sepsis in an admitting patient is drawing lactate. Dartmouth-Hitchcock found its turnaround time was 60 minutes. After implementing process improvements, that time was reduced to six minutes, Taenzer says.

"That sounds like something simple to do, but we brought everyone in a room for at least 20 hours total time, and just walked through the ED, [looking at] what is the patient flow? Where does one need to go to get the antibiotics? Where are they stored? Who replenishes them when they are being used? What are the optimal dosages? How can we simplify all that?" he says.

The team also adjusted the process to empower nurses to better identify potential sepsis patients that arrived in the ED. From there, it installed an accelerated pathway that would start the process of notifying the physician, drawing labs, ordering IVs, and alerting the rest of the ED staff that this was a high-priority case.

Timing is imperative in treating sepsis patients, but Taenzer says that nearly every delay they encountered with the three-hour bundle was process-oriented. The process improvements allowed clinicians to quickly identify sepsis patients and then get them started on antibiotics as soon as possible.

Zweig says the early detection of sepsis in the ED relies heavily on a fluid process.

"I think education can be helpful, but I think it's about having a hardwired and defined process for who should be doing that screening, and during the screening, what they should be looking for," she says. "Depending on what they are looking for, if they see potential signs of sepsis, who should they tell and what are the follow-up steps?"

Setting an aggressive goal

Dartmouth-Hitchcock president and CEO James N. Weinstein, MD, set an aggressive goal of hitting 80% compliance within 90 days. Initially, Taenzer admits he thought the goal was "a little lofty or ambitious," but it ultimately drove the team toward high standards of improvement.

"It's something that has to be learned from leaders in healthcare, that sometimes you have to set the goal as high as he did and go for it," Taenzer says.

The hospital was able to achieve such a rapid improvement for two reasons, Taenzer adds. First, they reached out to 16 other member hospitals in the High Value Healthcare Collaborative (HVHC).

North Shore-Long Island Jewish Hospital offered a sepsis identification tool and Intermountain Healthcare provided some suggestions for implementation improvements.

Second, Dartmouth-Hitchcock utilized professionals from its Value Institute, an initiative created in 2012 that utilizes "Lean Six Sigma" methodology to improve healthcare processes. Sam Shields, MBA, a performance improvement expert with the Value Institute, was imperative to the success of the intervention in the ED, and then later in transitioning to the ICU, Taenzer says.

"His background is chemical engineering," he says. "The same methodology that they use there to keep production safe and efficient can be used in healthcare. That was a key component to getting this done right."

Start in the ED

Statistics show that the identification of sepsis patients begins in the ED, which is why many healthcare organizations start by adjusting ED procedures and then move to other units, like the ICU.

According to The Advisory Board's Crimson program, which tracks data analytics from more than 1,000 hospitals, there is an 80-20 split that identifies where sepsis patients are coming into the hospital.

"When I'm talking to an organization who wants to improve sepsis outcomes, one of my first recommendations is you need to look at the ED because you're going to catch 80% [of] your patients based on this data set if you're more deliberate about screening for sepsis in ED triage," Zweig says.

She also notes that most hospitals have had success when screening tools or checklists are made available to ED nurses, who can use them to catch symptoms that may have otherwise gone unnoticed.

From there, the process can be tweaked to fit into other units. Dartmouth-Hitchcock has implemented a process in the ICU and rolled out an inpatient detection tool for the early identification of sepsis. Now clinicians are required to take an annual sepsis class, just as they would for CPR.

The hospital is also making efforts to attack sepsis at a community level, Taenzer says. Because patients are often transferred to Dartmouth-Hitchcock from surrounding areas, a delay in sepsis treatment can negatively impact those patients. Research shows that for each hour that the patient goes without antibiotics, the risk of mortality increases 8%.

Unlike other time-sensitive illnesses like stroke or heart attack, where small hospitals don't have the means to perform complicated interventions, sepsis prevention merely relies on administering fluids and antibiotics.

"Because that three-hour bundle is relatively easy to do, we really want the community hospitals to start that bundle and get it going and then send us the patient," Taenzer says.

Editor’s Note: This article originally appeared in HCPro’s Patient Safety Monitor Journal.



ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine