Progress Report 2017 OHA STATEWIDE SEPSIS MORTALITY REDUCTION INITIATIVE

1,486 13.4% LIVES REDUCTION IN SEPSIS SAVED MORTALITY

Data through year-end 2016 OHA QUALITY FOCUS AREA OHA Quality Initiatives Commit to Reduce Sepsis Mortality by 30% Efforts Focus on Early Recognition as More Than 80% of Cases Arrive at the Hospital Door

Ohio hospitals achieved a 13.4 percent Practice Topics program, or LEAPT. The topic of sepsis statewide reduction in sepsis mortality, has since been incorporated into several forums hosted by the quality team, such as the OHA Hospital representing an estimated 1,486 lives Improvement Innovation Network Hospitals, the Ohio saved over the first 18 months of the regional quality collaboratives, and the Clinical Advisory OHA initiative that began in June 2015. Committee of OHA’s Board of Trustees. In 2014, OHA facilitated a successful rapid cycle OHA launched the statewide initiative improvement initiative for sepsis through the LEAPT with a goal of reducing sepsis mortality program. This program included the initiation of an early warning system process, sepsis order sets for different in Ohio by 30 percent by year-end 2018. departments and reports for ease of auditing sepsis The target rate is 14.9 percent. cases. These achievements were necessary for complete implementation and evaluation of a sepsis program OHA and participating hospitals are taking the lead to resulting in a 32 percent reduction reported in sepsis decrease the number of sepsis deaths in Ohio by mortality among participating hospitals. increasing early recognition of the signs of sepsis and early, appropriate intervention throughout the continuum of care.

The OHA Board of Trustees identified and approved sepsis mortality reduction in Ohio hospitals as one of the key focus areas for OHA and Ohio hospitals for 2015–2018. 13.4% Specifically, OHA’s board-directed goal is to reduce sepsis 1,486 mortality by 30 percent by the end of 2018. LIVES REDUCTION IN SEPSIS SAVED MORTALITY A statewide sepsis initiative was launched by OHA’s clinical quality team led by James Guliano, MSN, RN-BC, FACHE, vice president, OHA Quality Programs, building on outcome strategies achieved during the association’s participation in the nationwide Leading Edge Advance Data through year-end 2016

ABOUT SEPSIS Sepsis is a life-threatening condition that arises when the body’s According to the CDC, the number of sepsis cases in the United overwhelming response to infection begins to cause injury and States increases every year. The NIH reports that sepsis causes more damage to tissues and organs. More than 38,000 Ohioans were deaths in the United States than prostate cancer, breast cancer and impacted by sepsis in 2016 and 7,380 did not survive. Many of these AIDS combined. patients continue to require additional health care services after surviving sepsis due to the complications of the disease. The World Health Assembly and the World Health Organization on May 26, 2017 made sepsis a global health priority by adopting a Early recognition and appropriate treatment can reduce the resolution to improve, prevent, diagnose and manage sepsis. morbidity and mortality of sepsis. Any infection can trigger sepsis, Additionally, on Aug. 23, 2016, the Centers of Disease Control and but the following types of infections are more likely to cause sepsis: Prevention declared sepsis a “medical emergency” encouraging pneumonia, abdominal infection, kidney infection or a bloodstream more awareness as “sepsis begins outside of the hospital for infection. nearly 80 percent of patients.” 2 CLINICAL FOCUS AREA Early Recognition, Early Appropriate Intervention Keys to Clinical Training Developed by OHA

OHA launched its statewide sepsis initiative in June 2015 as a Overall Sepsis Mortality collaborative for hospitals to join OVERALL SEPSIS MORTALITY 25% with two key strategies: to improve early recognition and 21.7% early, appropriate intervention with incorporation of the 13.4% 20% REDUCTION Surviving Sepsis Campaign’s three-hour sepsis bundle. 18.4%

Hospitals that joined the initiative 15% receive quarterly reports of their progress, access to monthly Overall Sepsis Mortality evidence-based educational and 2014 Baseline Rate = 21.3% coaching calls, as well as 10% 30% Reduction Target Rate = 14.9% additional resources and support Linear (Overall Sepsis Mortality) at no cost.

Additionally, participating 5% hospitals have reported the following activities:

• Coordinating with EMS/ 0% 15 16 15 16 15 16 15 16 15 16 15 15 16 16 15 16 15 16 15 16 15 15 16 16 ------ambulance services to - Jul Jul Jan Jan Jun Jun Oct Oct Apr Feb Apr Feb Sep Sep Aug Aug Dec Dec Nov Nov Mar Mar May provide sepsis education and May early appropriate intervention protocols • Assigning a dedicated “sepsis coordinator” to work with clinical • Incorporating national Sepsis Alliance templates for discharge team on policies and protocols instructions of sepsis patients • Expanding education for staff orientation • Reviewing rapid response team protocols and activation • Distributing a sepsis alert page throughout the hospital when a process to treat sepsis patients patient arrives or is identified as septic, creating a mandatory • Improving recognition and treatment before rapid response consult for a critical care physician and ensuring information is team is needed passed, including the time for the 6-hour focused exam and the location of the patient • Implementing Focused Assessments to determine condition of septic patient • Developing marketing materials such as radio ads and billboards to educate the community on the signs of sepsis • Creating and distributing education materials (signs of sepsis) for the community and partners

In 2017, OHA hosted four regional sepsis continuing medical education (CME) events throughout Ohio. Pictured is the regional event in the northwest region.

3 Hospitals Participating in the OHA Statewide Sepsis Initiative  Central Berger Health System Diley Ridge Medical Center Fairfield Medical Center Fayette County Memorial Hospital Knox Community Hospital Licking Memorial Hospital Mary Rutan Hospital Memorial Health Mount Carmel East Mount Carmel New Albany Mount Carmel St. Ann’s Mount Carmel West OhioHealth Doctors Hospital OhioHealth Dublin Methodist Hospital OhioHealth Grady Memorial Hospital OhioHealth OhioHealth Riverside Methodist Hospital The Ohio State University East Hospital The Ohio State University Richard M. Ross Heart Hospital The Ohio State University The James Cancer Hospital and Solove Research Institute The Ohio State University Wexner Center

 Northeast Affinity Medical Center Ashtabula County Medical Center Aultman Hospital Aultman Orrville Hospital Akron General Lodi Hospital Cleveland Clinic Akron General Medical Center Cleveland Clinic Avon Hospital Cleveland Clinic Euclid Hospital Cleveland Clinic Fairview Hospital Cleveland Clinic Hillcrest Hospital Cleveland Clinic Lodi Hospital  Northwest  Southeast Cleveland Clinic Lutheran Hospital Blanchard Valley Hospital Belmont Community Hospital Cleveland Clinic Main Campus Bluffton Hospital Coshocton Regional Medical Center Cleveland Clinic Marymount Hospital Bucyrus Community Hospital Genesis Healthcare System Cleveland Clinic Medina Hospital Community Hospitals & Wellness Centers—Bryan Hospital Holzer Gallipolis Cleveland Clinic South Pointe Hospital Community Hospitals & Wellness Centers—Montpelier Holzer Medical Center—Jackson East Liverpool City Hospital Firelands Regional Medical Center Marietta Memorial Hospital Lake Health Tripoint Medical Center Fisher-Titus Medical Center OhioHealth O’Bleness Hospital Lake Health West Medical Center Galion Community Hospital Selby General Hospital Mercy Hospital of Defiance Grand Lake Health System—Joint Township Southeastern Ohio Regional Medical Center Mercy Health—St. Anne Hospital District Memorial Hospital Mercy Health—St. Charles Hospital Henry County Hospital Mercy Health—St. Elizabeth Boardman Hospital  Southwest Magruder Hospital Mercy Health—St. Elizabeth Youngstown Mercer Health Adena Greenfield Medical Center Mercy Health—St. Joseph Warren Hospital Mercy Allen Hospital Adena Pike Medical Center Mercy Health—St. Rita's Medical Center Mercy Regional Medical Center Adena Regional Medical Center Mercy Health—St. Vincent Medical Center Mercy Medical Center CMH Regional Health System— Mercy Tiffin Hospital OhioHealth Hardin Memorial Hospital Clinton Memorial Hospital Mercy Willard Hospital OhioHealth Marion General Hospital King’s Daughters Medical Center Ohio MetroHealth System ProMedica Bay Park Hospital Mercy Health Anderson Hospital OhioHealth Mansfield Hospital ProMedica Defiance Regional Hospital Mercy Health Clermont Hospital OhioHealth Shelby Hospital ProMedica Flower Hospital Mercy Health Fairfield Hospital Pomerene Hospital ProMedica Fostoria Community Hospital Mercy Health West Hospital Salem Regional Medical Center ProMedica Memorial Hospital Mercy Memorial Hospital Southwest General Health Center ProMedica Toledo Hospital Mercy Springfield Regional Medical Center St. Vincent Charity Medical Center The Bellevue Hospital Mercy Lourdes Hospital (KY) Steward Health Care—Northside Medical Center University of Toledo Medical Center Premier Health Atrium Medical Center Steward Health Care—Trumbull Memorial Van Wert County Hospital Premier Health Good Samaritan Hospital Summa Health Wayne Healthcare Premier Health Union Hospital Wyandot Memorial Hospital Premier Health Miami Valley South University Hospitals Cleveland Medical Center Wood County Hospital Premier Health Upper Valley Medical Center University Hospitals Samaritan Medical Center Southern Ohio Medical Center Western Reserve Hospital The Christ Hospital The Jewish Hospital—Mercy Health UC Health Wilson Health 4 NATIONAL EXPERTS OHA Education OHA Hospital Teams Resources Available Learn from Leaders Online in Sepsis Care OHA’s quality program education materials and resources are available for hospitals and community partners to OHA quality team has provided member participants with access at www.ohiohospitals.org/sepsis. These online programming focused on a wide range of topics concerning resources features national publication articles, reports, sepsis featuring clinical experts and speakers from across the research studies and OHA monthly webinar recordings of nation including: professional and national sepsis experts and clinicians sharing their best practices. Additionally, OHA’s SOS • Steven Burdette, MD, FIDSA, FACP, professor of Medicine, campaign webpage features a member toolkit, Wright State University Boonshoft School of Medicine graphics, social media promotions and more at www.ohiohospitals.org/SOS. • Rommie L. Duckworth, LP, Founder and Director of the New England Center for Rescue and Emergency Medicine

• Katherine Eilenfeld, DO, Westshore Primary Care, Ohio

• Cindy Hou, DO, MBA, FACOI, Kennedy Health System, Stratford, New Jersey Sepsis is a race • Marianne Kraemer, MPA, MEd, BSN, RN, CCRN, Kennedy against time Health System, Stratford, New Jersey Symptoms of sepsis include: • James O’Brien, MD, MS, vice president, Quality and Patient Safety, OhioHealth; Board of Directors, Sepsis Alliance S – Shivering, fever or very cold – Extreme pain or general discomfort • Marlene Oliver, BSN, RN-BC, CHPN, University Hospitals E (“worst ever”) St. John Medical Center – Pale or discolored skin • Michael Patterson, DO, vice president, Medical Affairs, P OhioHealth Mansfield Hospital S – Sleepy, difficult to rouse, confused • Hallie Prescott, MD, MSc, assistant professor, Department I – “I feel like I might die” of Internal Medicine, Division of Pulmonary and Critical – Short of breath Care Medicine, University of Michigan S

• Cynthia Shellhaas, MD, MPH, The Ohio State University If you suspect sepsis (observe a Wexner Medical Center combination of these symptoms) see your medical professional immediately, CALL • Michael Taylor, MD, FACS, Medical Director, Surgical 911, or go to a hospital with an advocate Critical Care, Cleveland Clinic Fairview Hospital and say, “I AM CONCERNED ABOUT SEPSIS.”

• Stephen Thung, MD, The Ohio State University Wexner Medical Center

• Paul Zeeb, MD, Emergency Medicine Physicians, Mount Source: Carmel Health System; chair, Region IV Physician Advisory Board

5 LEADERSHIP ENGAGEMENT Hospital Leaders Support Sepsis Initiative

In the sepsis initiative, OHA has partnered with the Sepsis Alliance, and is advised by James O’Brien, MD, MS, founding member and board member for Sepsis Alliance. OHA’s 2016 Quality Summit featured a panel presentation on the continuum of care for sepsis. Pictured are (from left) Kelly Belcher, MSW, LISW, SNF CCN program manager, OhioHealth SNF Continuing Care Network; The OHA and Sepsis Alliance partnership Lisa Schlemmer, RN, BSN, CFRN, EMT-P, clinical manager, Air Care and Mobile Care, University of Cincinnati has included activities such as: Medical Center; James O’Brien, MD, MS, system vice president, Quality and Patient Safety, OhioHealth; and Charles von Gunten, MD, PhD, vice president, Medical Affairs, Hospice and Palliative Care, OhioHealth. Not conducting a community campaign, shown is panelist Shankar Kurra, MD, senior vice president, Medical Affairs, Fisher-Titus Medical Center. promoting sepsis awareness month observance with Ohio Governor’s proclamation, participating in the annual Spike Out Sepsis event held in Columbus, participating in the annual Sepsis Heroes event in New York City, and providing statewide professional continuing medical education.

The OHA Board further called for a measure of leadership commitment to achieving a reduction in sepsis mortality. Hospital leaders, mostly chief executive officers, were provided with a list of action categories and were asked to identify which actions were being undertaken, thereby demonstrating their commitment of leadership and operational resources.

The leadership action categories include: resource allocation at the hospital level, organizational sepsis certification, fostering a culture of learning, OHA and community partners launched the OHA SOS Campaign on Sept. 13, 2016 to promote the signs of accountability and sustainability, visible sepsis. Pictured are (from left) James Guliano, MSN, RN-BC, FACHE, vice president of Quality Programs, OHA; and vocal leadership endorsement, Amy Andres, senior vice president of Quality and Data, OHA; Jim O’Brien, MD, 2016 Chair, Board of Directors, identification of hospital metric(s) related Sepsis Alliance; Jen Ludwin, sepsis survivor; Nisha Hammel, director of Advocacy, LeadingAge Ohio; and Mike to sepsis mortality reduction, and joining Abrams, president and CEO, OHA. the OHA statewide sepsis initiative.

The organizational action categories collaboration across the provider continuum of care. Ninety percent include: incorporation of early recognition and early appropriate of the participating hospitals have submitted formal commitments intervention into staff performance evaluations and competency, indicating at least one action in the leadership and organizational action plan development for sepsis reduction, a focus upon areas currently being undertaken. opportunities for operational improvement, actively presenting an effective practice to peers in the OHA statewide sepsis initiative, and 6 COMMUNITY CAMPAIGN Community Partners Promote OHA SOS

In alignment with National Sepsis Awareness month in September, sepsis and leading to better patient outcomes. In addition, OHA is 2016, OHA launched another phase of the statewide campaign collaborating with pre-hospital providers in emergency medical introducing the OHA Signs of Sepsis initiative. To further the goal of services to develop a consistent hospital response to EMS- increasing early recognition and early, appropriate intervention, the generated sepsis alerts in order to promote early initiation of campaign targets hospitals and the community by reaching out to treatment in the field and timely continuation of appropriate caregivers, first responders and health care providers across the interventions by the receiving emergency department. continuum of health care services. Since the recent launch, OHA has incorporated partners in pre-hospital care, post-acute and long- To further enhance the collaboration and spread of information, term care, skilled nursing and assisted living facilities. formal educational programs were provided at the state level by OHA at the Ohio Association for Healthcare Quality Annual Sepsis Alliance and LeadingAge Ohio were the first to join OHA for Conference on May 19, 2016, Ohio’s LeadingAge Annual Conference this effort. The campaign will direct hospitals and community on Sept. 8, 2016, the Association for Health Information partner organizations to ohiohospitals.org/SOS where they will Management Association on Oct. 5, 2016, and the Ohio Organization submit their interest and support of sharing and promoting the of Nurse Executives on Nov. 10, 2016. Nationally, James O’Brien, MD, signs of sepsis to their constituencies. presented a CDC Town Hall presentation entitled, “How Three States Tackled Sepsis” on Aug. 30, 2016, showcasing the Ohio initiative OHA continues to expand this initiative by engaging community along-side Wisconsin and New York. partners through education and process improvement. Partnering with the Health Services Advisory Group or HSAG (Ohio’s QIO-QIN), Additionally, OHA’s initiative has been featured in Ohio and national OHA has provided sepsis education to nursing homes and home media publications and broadcasts including WOSU’s All Sides with health agencies in Ohio regarding early recognition and treatment of Ann Fisher, Becker’s Hospital Review, HealthLeaders, Fierce sepsis to better transition patients to the appropriate level of care in Healthcare, HealthScene Ohio and Gongwer. a timely fashion.

On Dec. 7, 2016, over 100 leaders of Ohio-based long-term care facilities AMERICAN HOSPITAL ASSOCIATION attended an educational program jointly presented by OHA and HSAG with emphasis Dick Davidson upon early recognition and a communication strategy for escalating clinical concerns to seek a higher level of care in a Quality timely fashion, thereby halting the progression of Milestone Award FOR ALLIED ASSOCIATION LEADERSHIP

Ohio Governor John Kasich 2017 HONORABLE MENTION declared September as Sepsis Awareness Month in In 2017, OHA and its SOS campaign received the American Hospital 2016 and 2017. Association’s Dick Davidson Quality Milestone Honorable Mention Award for Allied Association Leadership. 7

In 2015 OHA launched a statewide quality collaborative to reduce sepsis mortality in Ohio. In the first 16 months of the initiative, 123 hospitals joined, achieved an reduction lives in sepsis % and saved. 11 mortality 1,313 This represents 57 percent of the OHA membership, 100 percent of the OHA HIIN hospitals, and 79 percent of the inpatient encounters for the state of Ohio.

Workplace Since 2014 a cohort of Ohio hospitals demonstrated a Safety % reduction in safe patient Program 41 handling incidents while reducing severity 70 percent resulting in more than $115,000 in cost savings. CALL TO ACTION Join OHA’s SOS Campaign and Promote the Signs of Sepsis

Take Action

SEPSIS Join the OHA SOS Campaign— CAMPAIGN visit www.ohiohospitals.org/sos. Be a Lifesaver—Know the Signs of Sepsis MEMBER AND Talking Points The Ohio Hospital Association is taking the lead to reduce need to access early intervention. The campaign engages PARTNER sepsis mortality in Ohio byBe 30 percenta Lifesaver—Know by the end of 2018 caregivers, first responders the andSigns health care providersof Sepsis by launching a statewide campaign—OHA SOS—to throughout the continuum of health care services. TOOLKIT increase early recognition of the signs of sepsis and the More than 38,000 Ohioans were impacted by sepsis last year, and 7,380 did not survive. The Call to Action Total Community Effort: EMTS, OHA Members Committed to Home Health,Prevention: Long-Term The risk Care of sepsis can be Saving Lives in Ohio The campaign directsThe hospitals Ohio Hospital and Association is reduced by preventing infections; practicing community partnercommitted organizations to toreducing sepsis mortality good hygiene and staying current with ohiohospitals.org/SOSin Ohio where by 30 they percent will by the• end Sepsis, of sometimes referred to as • OHA launched the initialSepsis phase is ofa thisrace early “blood poisoning”vaccinations. by the general public, is a recognition/early intervention campaign see the six signs of2018 sepsis through and can downloadearly recognition and against time a toolkit. life-threatening condition that arises when with frontline hospital teams in late 2015. Treatment: Sepsis is a medical emergency early intervention. the body’s overwhelming response to • Ohio hospitals have measuredSymptoms a 13.4 of sepsis percent include: infection beginsthat to cause requires injury urgent and damage attention and rapid treatment for survival. improvement in just the first 18 months of the to tissues and organs. – Shivering, fever or very cold Most ExpensiveOHA and Condition our member in hospitals across initiative, representingS 1,486 lives saved. – Extreme pain or general Access the campaign toolkit— All of Healththe state Care; have Affects educated staff• toMore than 80 percentRecovery: of cases Many arrive individuals at the recover fully E discomfort (“worst ever”) 38,000 Ohioansrecognize Annually the signs of sepsis andhospital door, whilefrom sepsissepsis emerges while many in the others have balance of patientslong-lasting affected effects, after they such arrive as amputations or – Pale or discolored skin begin a proven bundle of immediate organ dysfunction, like kidney failure. Other P at the hospital for the original infection, • Sepsis is the mostinterventions expensive condition to save to lives. The after-effects of sepsis are less obvious, such S – Sleepy, difficult to rouse, confused organize an event, distribute such as pneumonia or an abscessed tooth. treat in the entirecampaign U.S. health includes care system caregivers, first as memory loss, anxiety or depression.OHA ResourcesI – “I feel like I might die” accounting for $24 billion in annual costs, or responders and health care •providers The OHA SOS effort includes OHA member – Short of breath 6.2 percent of all hospital costs. Sepsis kills hospitals and providers throughout the S across the continuum of care. Critical Facts Communication Resources information, build a webpage. 258,000 people in the United States every continuum of care—from EMTs and home If you suspect sepsis (observe a year—more than breast cancer, prostate health providers, to hospital ERs, to • www.ohiohospitals.org/SOScombination of these symptoms) • Sepsis affects over 26 million people cancer and lung cancer combined. long-term care facilities. see your medical professional Facts worldwide each year and is the largest immediately, CALL 911, or go to a killer of children and newborn infantsClinical in Resources • In 2016, Ohio hospitalsDefinition: treated Sepsis more is thethan body’s overwhelming• Early recognition of the signs of sepsis and hospital with an advocate and say, the world. More than 258,000 people• die 38,000 patientsand for severe life-threatening sepsis or septic response to infectiontreatment with a recognized three-hour www.ohiohospitals.org/sepsis“I AM CONCERNED ABOUT SEPSIS.” in the U.S. each year from Sepsis. 155 E. Broad St., Suite 301 • Columbus, OH 43215-3640 • 614.221.7614 • 614.221.4771 • shock. Of those, 7,380 died. treatment bundle is effective in dramatically t f ohiohospitals.org which can lead to tissue damage, organ OHA’s quality program education improving outcomes for patients. failure and death. • Sepsis can be treated effectivelymaterials if and resources are available for • Early recognition and early intervention are recognized early. Mortality fromhospitals sepsis and communitySource: partners to key to survival—but less than 1 percent of • The challenge: several of the signs are fairly More than 80 percent of cases develop in increases 8 percent every hour thataccess. Americans can theidentify community. the symptoms In some of patients, sepsisconsistent with exercisetreatment and isother delayed. benign sepsis. emerges after the patient arrives at theactivities. hospital seeking treatment for an underlying • Sepsis is the No. 1 cost of hospitalization Learn more about sepsis and infection. in the U.S. consuming more than $24 billion each year. how caregivers, first responders Who it Hurts: While sepsis is more likely to and health care providers can join affect very young children, older adults and • Early recognition and early intervention the OHA fight to reduce sepsis those with a weakened immune system, are key to survival—but less than 1 deaths in Ohio by 30 percent at sepsis is an equal opportunity155 E. Broad St., killer Suite 301 • Columbus,percent OH 43215-3640 of Americans • t 614.221.7614 can identify • f 614.221.4771 the • ohiohospitals.org impacting the sick, the well and people of symptoms of sepsis. ohiohospitals.org/SOS. all ages. Contact James Guliano, 155 E. Broad St., Suite 301 • Columbus, OH 43215-3640 • t 614.221.7614 • f 614.221.4771 • ohiohospitals.org MSN, RN-BC, FACHE Vice President for Quality Programs [email protected] 614-221-7614.

OHA QUALITY PROGRAMS TEAM

Amy Andres Rosalie Weakland, RN, MSN, CPHQ, FACHE Ellen Hughes, RN, ACA, LNC Senior Vice President, Quality & Data Senior Director, Quality Programs Quality Coordinator [email protected] [email protected] [email protected]

James Guliano, MSN, RN-BC, FACHE Ryan Everett, MPH Dorothy Aldridge Vice President, Quality Programs Director, Population Health Quality & Data Coordinator [email protected] [email protected] [email protected]

155 E. Broad St., Suite 301 • Columbus, OH 43215-3640 • t 614-221-7614 • f 614-221-4771

ohiohospitals.org : /helpingohiohospitals : @ohiohospitals