Rationale / Objectives
Project/Program Description & Major Achievements
People / Organizations Involved
Hospital Standardized Mortality Ratio (HSMR) measures real versus expected mortality over time. HSMR is used to monitor service quality for hospital inpatients with common diagnoses.1 From 2007-09, Baylor Scott & White - North Texas Division (Baylor) recorded a high HSMR for inpatients with sepsis; more deaths occurred than expected based on the US national average.1 Baylor’s goal was to reduce the HSMR for inpatients with sepsis. The organization needed to involve staff and manage change to create a sustainable solution. It aimed to develop a reporting system to drive ongoing engagement, awareness, and accountability for sepsis mortality reduction.1 Baylor’s Emergency Department Practice Council developed tools, expectations, and a reporting process, which led to better care processes and lower mortality rates (HSMR).1
Diagnosis Process: The new process begins with faster diagnostic testing after patients register at the emergency department. The triage nurse is responsible for screening patients for sepsis upon arrival. If the result is positive, the patient receives an expedited lactate test to confirm sepsis.
- Online sepsis screening tool in the ED information system
- Difficult IV-Start algorithm
Management Process: A new protocol is followed to manage early sepsis risk factors, following a positive lactate test. Clinicians deliver faster treatment by following the ‘difficult IV-start’ protocol, expediting IV access to administer antibiotics and intravenous fluids. Inpatient admission orders are standardized to maintain continuity of care.
- Daily huddle boards to engage frontline clinicians
- Standardized transparent compliance reporting for expected processes
|Metric||Goal||Result (Mar. 2012 → Jun. 2014)|
|Time to ABX in ED: % cases within 180 min||increased||↑ 28% (66% → 94%)|
|Time to ABX in ED: Avg minutes||decreased||↓ 54 min (120 → 66 min)|
|Time to IVF bolus completion: % cases within 180 min||increased||↑ 17 % (66 → 83%)|
|Time to IVF bolus completion: Avg minutes||decreased||↓ 45 min (135 → 90 min)|
|HSMR (Target: <1.0)||1.205||1.128||0.964||0.895||0.815||0.709||0.754|