Cone Health Exceeds Quality Goals for Sepsis Initiative Using Premier’s PINC AI™ Quality Enterprise

Key takeaways:

• Sepsis is a key driver of hospital mortality, readmissions and cost. To counter the rising effects of sepsis, innovative treatment and care strategies are needed.
• Cone Health utilized PINC AI™ technology to improve its sepsis treatment process. The health system aimed to obtain high SEP-1 bundle compliance rates to meet its compliance goals.
• Cone Health was able to improve SEP-1 bundle compliance using PINC AI™ Quality Enterprise and is now regularly achieving their target of 80 percent monthly.

The healthcare industry is at a pivotal point as several interconnected challenges and crises develop concurrently. The COVID-19 pandemic, high inflation rates, labor shortages and supply chain issues all continue to put a significant financial burden on healthcare organizations.

One of the most crucial things health systems can do to chart a positive financial path forward is to improve sepsis care. Typically, the most expensive hospital stay, sepsis is a time-sensitive illness that requires early detection and new treatments and care strategies to reduce patient mortality rates. This is especially true given the healthcare sector's ongoing transition to value-based care, which increases the focus on managing total care costs and reducing readmission rates.

Sepsis at Cone Health

Cone Health, a not-for-profit health system serving North Carolina, aimed to boost organizational compliance with the Severe Sepsis and Septic Shock Management Bundle (SEP-1), a National Quality Forum measure adopted by the Centers for Medicare & Medicaid Services (CMS), and reduce sepsis-related mortality.

There is evidence that measuring performance leads to better patient outcomes. SEP-1 provides guidelines for hospital staff treating sepsis. The SEP-1 bundle requires healthcare organizations to collect and report data regarding their adherence to the guidelines. Health systems aim to achieve 100 percent SEP-1 compliance, but the national average is about 60 percent. “We knew that we were better than what you could see on paper that was publicly reported, and so we needed to bring that forward and implement workflow processes,” said Angela Moore, Quality Nurse at Cone Health.

Cone Health needed meaningful data that could be utilized to assess performance; however, it was challenging to get relevant data that could be used for direct reform efforts while their sepsis documentation was not standardized. The time-consuming manual case reviews required to evaluate performance delayed the Cone Health team’s feedback to their clinicians.

PINC AI™ Data Opens Doors to Improving Sepsis Mortality

The health system tapped into the PINC AI™ Quality Enterprise solution to monitor performance and identify areas to improve. The Cone Health team implemented the PINC AI™ quality analytics solution for near-real-time actionable data to help with early sepsis recognition and early intervention for severe sepsis to reduce mortality and cost.

“Prior to using PINC AI™ technology, we were getting our cases monthly instead of weekly. Now that we get them weekly, we are more proactive with reviewing cases and giving our physicians feedback faster,” said Pam Smith, Quality Nurse at Cone Health. “We've also gotten feedback from our providers and nurses, and they really like being able to review the cases in a timely manner so that they can remember the case. So, it’s been a win-win from both sides.”

Cone Health thoroughly analyzed its data using the PINC AI™ Quality Enterprise solution and found between 85 and 90 percent of its sepsis patients had been admitted via the emergency department (ED). This finding prompted extra, targeted education for ED clinicians on early sepsis recognition. Cone Health gave feedback on the efficacy of the sepsis improvement program through department meetings and peer-to-peer talks, enabling the release of important information on how the use of the SEP-1 bundle improves patient outcomes.

Combatting Sepsis is a Team Effort

To help staff provide patients with evidence-based care, Cone Health set out to find opportunities for cross-departmental collaboration across nursing, physicians, quality and IT. They then implemented a system-wide sepsis alert that was established for the electronic medical record (EMR).

Cone Health utilized the PINC AI™ Risk Calculator tool to enhance EMR findings and help educate clinicians and coders about the impact clinical documentation has on quality outcomes. The goal is to ensure that the accurate severity of a patient at the time of admission is captured in the EMR and subsequently described through available ICD-10 codes. ICD-10 is a system that clinicians use to categorize and code diagnoses, symptoms and procedures for claims processing. Healthcare staff must carefully review ICD-10 guidelines and clinical documentation to assign the right codes for sepsis, severe sepsis and septic shock.

“We're starting to figure out what we can document that will help show how sick these patients really are and really risk adjust them. So, it’s a learning process, and I think every time we review charts, we learn a little bit more and we share that information with our coding team, our physicians and our clinical documentation improvement (CDI) team,” said Laurie Freeman, Quality Nurse at Cone Health.

The risk calculator tool was a game changer for Cone Health and helped their team manage the observed over expected outcomes. “We've been able to use the risk calculator to look at patients right after their discharge, make sure that we have the accurate coding in there and that it is coded to the highest Diagnosis Related Group (DRG) for reimbursement as well as quality,” said Freeman.

Next Steps for Improving Sepsis Care

By implementing a data-driven strategy for early diagnosis and reducing variation in sepsis care, Cone Health’s journey has led to considerable improvements in the outcomes for sepsis patients. The health system, which initially received a low score for SEP-1 bundle compliance, is now routinely exceeding their goal of 80 percent on a monthly basis. “I can tell you that since we started this work, our mortality and length of stay for sepsis have dropped drastically,” said Jessica Thomas, Quality Nurse at Cone Health. Furthermore, Cone Health projects $12 million in annual cost savings as a result of their improvement efforts and utilizing PINC AI™ technology.

Cone Health’s sepsis initiative is ongoing, and the team is continually learning and refining the process. In an effort to replicate the successes of their campaign to improve sepsis care, the health system has expanded its focus to include mortality as a whole. As a result, Cone Health now sits at the top decile for mortality. “It’s not an easy process. It takes time, patience and team collaboration,” said Moore. “We appreciate Premier's support and partnership in helping us revamp our sepsis care.”

Change is often a challenge that must be approached with an intentional strategy, and in the case of sepsis, it's imperative. By making adjustments in three key areas - people, process and technology - healthcare organizations can provide high-quality care all while reducing costs.

Learn more about how PINC AI™ solutions can help your healthcare organization achieve significant sepsis performance improvement.

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