A More Accurate Sepsis Identification Method: Leveraging Physiological Data

健康专家估计，当有害微生物进入血液或其他身体组织时，会影响生命的败血症会影响健康1.7 million people a yearin the United States, leading to hundreds of thousands of preventable deaths.

Any health system must meet the challenge of finding and implementing a sepsis identification process, and most organizations can improve the way they handle sepsis care. Rather than the current practice using administrative codes as the only means to determine how care is delivered to patients with sepsis, clinical leaders can consider more effective sepsis identification methods, such as leveraging physiological data.

Traditional Sepsis Identification Methods Leave Opportunity for Improvement

传统上，为了确定患者是否患有败血症，临床医生会完成患者来访的出院总结。除了书面医嘱、患者的健康史、病程记录和体检外，编码/账单部门的工作人员还使用医疗保健提供者文档中的信息来确定患者是否患有败血症以及严重程度。编码/计费部门还确定败血症的病因(如肺炎、肾盂肾炎、蜂窝组织炎等)。

The problem with this administrative, coding-based process is that the coder may assign sepsis as a diagnosis when it isn’t sepsis (it just looks like it should be sepsis), or vice versa.Researchalso suggests that administrative coders are more likely to diagnose sepsis due to higher levels of sepsis awareness, personal biases, and financial incentives (sepsis has a higherreimbursement ratethan other conditions, such as pneumonia) (Figure 1).

Issues with inaccurate sepsis diagnoses include skewing the number of patients in a health system who, in fact, have sepsis, leading to unreliable sepsis outcomesdata．Inaccurate diagnoses also delay the right care for patients who have a condition other than sepsis, leading to worse outcomes.

A New Sepsis Identification Method: Physiological Data

另一种识别败血症患者的方法是依靠他们的生理数据，而不是临床文件的账单代码。卫生系统将使用生理数据——例如病人的生命体征、器官衰竭的迹象、血液培养顺序和抗生素处方——来确定病人是否真的感染了。虽然编码人员经常正确诊断败血症，但行政编码方法仍然不如依赖患者的实际生理参数准确。

In essence, using physiological data, health teams can see a group of patients in two cohorts:

• In a diagnostic cohort, users see what the care team—including the coder/biller—interpret.
• In a physiologic cohort, users see only what the patient’s physiological data tells them, removing any biases or anecdotal information that could be misleading or incorrect.

The Right Tools Lay the Foundation for Successful Sepsis Management

Better sepsis management starts with an understanding of the role physiological data plays in sepsis identification. However, health systems can only go so far without the right tools. Data management tools, like a robust data warehouse andanalytics platform, play an essential role in early sepsis identification. Without the ability to access physiological data and customize the sepsis criteria based on a hospital’s unique needs, health systems reach an impasse.

TheCenters for Disease Control and Prevention(CDC) created atoolkit卫生组织可以利用这些数据建立一个基于生理数据的队列。该工具包包括关于识别和跟踪最高优先级因素的深入说明，帮助护理团队了解哪些患者被定义为感染性疾病。

Health systems can also leverage the Health Catalyst®Sepsis Analytic Acceleratorto guide sepsis development and improvements around any of five specific areas:

1. 急诊的早期识别。
2. Bundle compliance.
3. In-house sepsis recognition: The Health CatalystPatient Safety Monitor™ Application．
4. Compliance toSociety for Critical Care Medicine and Surviving Sepsis Campaigncare guidelines.
5. Readmissions.

After health systems have identified and implemented sepsis improvement interventions, leaders can leverage advanced benchmarking tools, such as the Health CatalystTouchstone™application, to compare sepsis improvement results with other systems to serve as a benchmark throughout theimprovement process．

Using tools like the CDC’s toolkit together with the Sepsis Analytic Accelerator and Touchstone will help health systems guide their sepsis management efforts and offer course correction before any intervention is too far off track. With the right tools, improvement teams can regularly track sepsis rates and understand if their interventions are making a difference.

A Clinical and Scientific Lens Leads to Accurate Sepsis Data

Filtering cohorts based on physiological parameters has benefits in addition to increased accuracy. It is a more clinical and scientific, and therefore objective, approach to patient identification, eliminating anecdotal information from a doctor’s notes—such as “patient seemed fatigued and short of breath”—and instead looking at a patient’s oxygen levels. Physiological filtering also removes the incentive to bill for sepsis, as it is a higher paying reimbursement.

As health systems begin to look at patient data related to a physiological sepsis cohort, in particular the process metrics for treating sepsis (e.g.,three-hour bundlemetrics), leaders will likely see that patients in the physiologic cohort respond significantly better to the interventions because those patients are actually septic, compared to part of a cohort inaccurately coded as septic. Patients who are not actually septic won’t respond as favorably to specific sepsis interventions, leading to inaccurate data and wasted resources. The data from the physiological cohort not only helps providers administer the right interventions to treat the right patients, but offers additional opportunities to improve care because the right patients are being diagnosed with sepsis earlier, leaving more time for providers to intervene.

With a new cohort based on the body’s unbiased, objective physiological information, health teams will learn that the actual sepsis population is most likely lower than the numbers in the coded population. Increased accuracy in sepsis rates should potentially demonstrate a decrease in other data sets, like sepsis mortality rates.

An Effective Sepsis Identification Method Is Key to Effective Interventions

The traditional coding-based sepsis identification method can be variable and often inaccurate. In a healthcare landscape in whichreimbursements卫生系统必须确定正确的群组来对败血症患者进行分类，使提供者能够尽早进行干预，并毫不拖延地向每个患者提供正确的护理。

As health systems build cohorts for patients with sepsis based on physiological data—rather than relying on a coder to decipher a doctor’s notes—clinicians can provide the correct targeted interventions to patients who are indeed septic. Once an effective sepsis identification method is in place, health systems are free to focus on intervention and helping patients with sepsis get on the road to recovery.

Additional Reading

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