Dr. Kencee K. Graves
Dr. Horton and collaborator Kencee K. Graves, MD, an academic hospitalist at the University of Utah, Salt Lake City, agreed that “face time” was the best way to get buy-in throughout their hospital during their own QI initiative. “We spent a lot of time sitting and listening to concerns and feedback from providers,” Dr. Graves said. “We would then integrate some of their feedback into the process, so people they knew they were heard.” Securing the buy-in of nursing staff was another huge key to their success in improving the quality of sepsis care and reducing costs.4 “Honestly, they were the secret sauce of the whole project,” Dr. Horton said. Changing the culture in the hospital helped immensely but required considerable time and patience to build both trust and acceptance within different units.
Based on their success, the QI initiative has spread to two other hospitals in the University of Utah’s network. “Once the culture changes have been made and the project’s up and going, it’s kind of self-sufficient,” Dr. Horton said. “But it was so much work.” He and Dr. Graves are careful to emphasize that there are other options for sepsis-related QI efforts. “I think it is better to start something small than to believe you can’t do anything at all,” Dr. Graves said.
No matter what the size, assembling a motivated and multidisciplinary team is critical, she said. So is empowering nurses to talk to physicians about decompensating patients and other aspects of sepsis care. Being available and willing to listen to other providers also can pay big dividends. “Knowing that we cared about the project’s success was important to people working on it,” Dr. Graves said.
Despite the remaining challenges, Dr. Shieh points out that sepsis mortality rates have improved significantly, thanks in large part to more awareness and ambitious QI projects. “I do want to say that we have come a long way,” she said.
References
1. Levy MM et al. Surviving Sepsis Campaign: Association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med. 2014 Nov;40(11):1623-33.
2. Singer M et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.
3. Schorr C et al. Implementation of a multicenter performance improvement program for early detection and treatment of severe sepsis in general medical-surgical wards. J Hosp Med. 2016 Nov;11:S32-9.
4. Lee VS et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA. 2016 Sep 13;316(10):1061-72.