This is Alan Connan with the Becker's Healthcare
Podcast. And today, I'm delighted to be joined
by doctor Christopher Thomas, vice president and chief
quality officer of Franciscan Missionaries of Our Lady
Health System. That's a 10 hospital
nonprofit health system headquartered
in Baton Rouge, Louisiana.
Doctor Thomas, pleasure to have you on the
podcast with us today. Before we dive into
our discussion, I'd love to just firstly hand
the hand the floor over to you, hear
a little bit more about your background and
your role at the health system.
Yeah. Happy to be on.
I am a pulmonary and critical care physician
by training.
Moved into that
area because I was concerned and wanted to
kinda investigate critical illness, and and that's how
I ended up in sepsis.
I grew up in a small town in
West Virginia.
And then when I joined our health system
here, was afforded the opportunity to think about
safety at scale
and how we can improve the overall outcome
of many patients. So,
moved into the role of chief quality officer,
after a stint as medical director of system
quality and patient safety
over the last three to four years.
That's been kind of a journey of moving
from the research elements over to the application
of evidence based medicine, which for us is
quality and trying to bridge the gap in
between
a publication that says we should do
a certain intervention for patients and then the
time it takes us to get every patient
within our health system to be able to
realize those benefits.
Got it. And I really appreciate the the
brief kind of background and perspective there. And
I understand
big, big core part of your focus. Like
you said, moving from that research to the
application
of evidence based medicine,
and I understand you you recently led a
a landmark initiative that achieved
a thirty nine percent reduction in sepsis
mortality at the health system. I'm eager and
excited to hear more about this significant achievement.
So
to kick things off, could you begin by
walking us through
the moment that you realized that this was
a critical issue that your health system needed
to tackle?
When we look at the major reasons patients
come in the hospitals
and when they leave hospitals, they don't return
to the same level of function to their
families. The disease that we become the most
concerned with is sepsis.
So as we began to evaluate how do
we think of all of the patients who
are coming into our health system and what's
the most impactful disease
that would get patients back to their dinner
tables and get them to living,
we decided this was the one. If you
ask me retrospectively whether that was a great
decision, I would tell you,
I probably should have started in something that
was easier.
But globally for us, when you,
come off of the pandemic, what you're really
trying to understand is patients have a risk
to develop an infection.
And then when they develop an infection, the
body either responds appropriately
or it responds in an abnormal way and
and creates this area where all of the
organs respond to the presence of infection.
We were really interested in that the majority
of people who show up to the ER
have an infection.
And if they have an infection in that
group, who is going to be those who
get really sick, and who are gonna be
those that we can say,
I think you're okay for right now and
you can go home.
So in taking care of our communities that
we're privileged to serve, it was the disease
that
came to our our forefront and said, if
we're gonna be really good
for our hospitals in Louisiana and Mississippi,
we need to be really good at this
disease, and that's kind of when we first
started to look at it. From a personal
journey,
I actually experienced this with my father.
And so it's always been a personal,
evaluation
of, hey. He had a routine procedure. He
got an infection, and then he became critically
ill. And so I began to think before
I ever joined our health system, what would
that be like if it wasn't my dad,
but it was someone else's family? And could
I be confident as the quality officer for
us that every single time, every single patient
would get the same approach and get the
same results that he was fortunate to have
when I was in medical school?
I'm curious to just follow-up. And out of
those patients that present to the emergency department,
can you talk us a little bit about
how you identify
those patients with infections that were going to
be really sick and and needed to be
treated and stayed perhaps in the hospital, and
those patients who presented in the ED with
an infection but were perhaps healthy and strong
enough to fight that infection and maybe return
home.
Yeah. This is a fantastic question and one
that's really critical across The United States. There
are many diseases
where we're very clear
the severity of illness related to the test
that we have. So,
for example, if you come in with chest
pain and you have a very specific change
on your EKG,
something that we call a ST elevation myocardial
infarction, we take you immediately to the cath
lab. And we know that the patients who
do not have that specific change
won't have a severity of an illness as
that patient. We know that in stroke care
that when you come in and we get
a CAT scan and we see a blockage
in a vessel in your brain, that we
need to be able in our comprehensive stroke
centers to go and get that clot out.
For us in sepsis up to about three
years ago when we began this journey,
what I would tell you is we just
were forced to assume
that everyone
who had an infection was at risk to
develop,
an abnormal response and get markedly sicker. And
so we, by definition,
overtreated
all the patients. So you brought up a
really great point. That meant that there were
people who we watched in the hospital
who probably were able to go home and
then on the other side of it, you
had to be perfect
in your assessment of who were the ones
that were gonna get sick. And it was
less elite than our
management of things like trauma and heart attack
and stroke. It just didn't meet the same
standard of where we were trying to go
from an excellence perspective.
So that was the very first question we
looked at is, what do we need? How
do we create a structure
that takes those patients who, as you described,
some could go home and some are gonna
get really sick, and how do we figure
out who is who? And that led us
to both the research and then implementation
of a new diagnostic test,
that was developed. It's brought by a company
called CytoVAIL and Intelycep. And so it was
a key feature for us in creating this
pathway
to being able to pick out the right
patient at the right time as opposed to
all of the patients getting everything.
Got it. And that makes a ton of
sense. It was kind of the first question
that's sprung into my mind when I when
I was reading about this study and this
this significant achievement on your part and by
the everyone at your team with the health
system. Ties right into my next question, which
I wanted to to pry on. What were
the biggest gaps in sepsis triage and management
that you identified early in the process, particularly,
like we said, in the emergency department?
Yeah. I think we didn't use our talent
well, to be honest, and this is a
a challenge across The United States. We had
experts in being able to suspect people of
having infections. That was our nurse triage team.
We weren't using them and giving them tools
in a way that could be repeatable in
every single time.
So that was the first step. The second
step is we needed to listen to our
teams who said, hey. There are
procedures that we wanna do to patients to
help them, and then there are procedures we're
doing the patients that don't help them. That
was something called blood cultures. So we listened
to our phlebotomy team and our nurses to
kind of start a process that started with
the nurses and then nurse initiated or set,
and then develop a set of labs that
told us who was at high risk and
who was not. And that new addition in
that triage is that's where the Intelycep test
for us became super helpful. It allowed us
to change to look at the patients and
say, you are very sick, and we're gonna
come give you as much treatment early as
possible. And then it allowed us to look
at the patients
where it was very clear over ninety seven
to ninety eight percent of the time, they
were not gonna progress to this threatening thing
that we call sepsis and allow us to
treat them in an individual manner, personalized still,
but not expose them to all of the
testing and all of the procedures that are
necessary when the patients are really critically ill.
So,
the take home from that is triage had
to be optimized,
and then we had to have a pathway
where we could get to something that told
us you're gonna get sick or you're not,
and then allow our teams of just elite,
emergency department physicians
who they're gonna go to the first and
get to the amount of treatment that's necessary
in terms of antibiotics
and then evaluating them and having a good
conversation with their families about how concerned we
are about them.
Curious if you could just talk one bit
more about
rallying at at the talent,
the staff, the clinicians at your organization,
kind of what you did specifically differently in
terms of the tools you provided them, the
resources, perhaps the education to really kinda really
help secure that buy in and drive towards
these results?
Yeah. We have a phenomenal performance improvement team,
here at Our Lady of Lake Health and
as part of the system. And the first
thing we did was took the voice of
those,
team members who said, we wanna get several
things correct.
We wanna make sure that we get into
the waiting room and pull out patients who
are sick, who may not look really sick.
We wanna make sure that we have this
correct recognition of the patients who do have
sepsis.
We wanna make sure that the patients were
taken care of,
stay in the hospital for a very short
period of time or shorter compared to others.
We wanna make sure that they are able
to survive.
And then
the teams also told us a really interesting
concept that's critical to this is they also
said,
we also wanna look at the patients who
before we thought were septic but are really
sick and who aren't septic. And we wanna
have a pathway where we can pivot off
of them. So we call this people process
and pivot. We took the talent of the
people. That's the ER, the phlebotomist, the pharmacist,
our performance improvement team. We put them in
a room every week,
and we looked at every single result over
an entire year and continued to iteratively improve
the process that we were creating. We let
them tell us what was working and what
wasn't working, and so we could get to,
like, a final really good structure that you
see in those results of the reduction in
in mortality relative by thirty nine percent,
a length of stay reduction of point seven
six.
But more specifically, when you put those people
together in a room in performance improvement,
they then begin to drive the change
related to other things surrounding the disease. And
so what we learned is that they were
much more comfortable in having the conversation about
sepsis with the patients. They were able to
enhance
the conversation about risk with the patients.
And so the biggest part about this is
the ability to implement a really novel diagnostic,
but at the same time, kind of
estimate the talent of your internal team,
recognize when they're really supremely talented, and then
put them into a process and a structure
where they can show that talent. And that's
what we've been able to do, not only
for where the first pilot location in The
United States was of this process, our Lady
of the Lake Regional Medical Center in Baton
Rouge, but now in the rest of our
health system to repeat and replicate that kind
of process. And so it's been really rewarding.
Fantastic. The the three p's, people, process, and
pivot. Love that.
Obviously, the results really speak for themselves. I
mean, hats off to to you and the
fantastic team around you.
What are the next steps? And in terms
of driving even further, even more substantial results
results around sepsis, how are you looking to
continue the great work that you're doing across
the health system?
Yeah. I think this just comes back to
listening to the team. So here's what they've
told us. Before we started this process versus
after, the after process for every a hundred
and ten patients we put through this structure,
we save one life.
For every patient,
comparatively
from before and after who comes up with
a high risk test,
we save it takes about 24 of those
tests. So the number needed to treat based
on that high risk result is twenty four.
So we're taking those numbers and we're saying
where else in this journey of the pathway
of the sepsis patient
can we help further improve the care? So
we're now looking at how our antibiotic use
and which antibiotics that we're using, how can
we optimize that. Meaning, if you don't need
a very broad antibiotic, let's not give it
to you. Let's be very specific and tailored.
We're also beginning to look at, well, what
who are those patients that we think we're
gonna need to admit to the hospital, but
the next twenty four hours to thirty six
hours is gonna dictate to us whether you're
gonna potentially get sicker or whether you're gonna
get to go home. So we're focusing in
on them. That's for us a process that
we call rescuing the patient. So recognizing the
disease and making sure that if they were
gonna get sicker, we have to think about
the rescue.
And then
on the last part, this is also about
adding other data to this this new novel
way to look at sepsis. So if I
have my dad who would have come in
and he talks to our emergency department team
and they triage him, and then he gets
the test and the test says he's high
risk. And then as we think about him
being high risk,
what are the other things that we need
to do for him to ensure that he
gets to go home? And so adding things
like a structured mobility program because we know
sepsis patients get weaker which we have. And
let's then look about what his needs are
gonna be two and three days later so
that when he's discharged, we wanna make sure
that he understands the disease he had and
that he sees his primary care physician
within the next seven days.
So really thinking about this holistically,
this process looked about the inpatient
ability to triage and identify a sepsis patient.
And now as you take a step back,
what we've begun to really think is we're
world class in the results and recognition, and
we're world class in the results of treatment,
but we'd like to be world class
in preventing you from ever needing to come
into the hospital. And then if you had
to, if it was unfortunate enough that you
get infection and you get sepsis,
what are we doing on the backside that's
really meaningful in the same results that we've
seen here?
Sometimes we think meaning is just,
checking a box to do something. What our
teams are pushing us to do is if
we do something, I wanna make sure that
it helps
someone's mother, brother,
you know, sister, father. And so, really just
a congratulations
to the team to continue to push us
in what we do because I think many
places would stop at this level of success
in terms of length of stay and mortality.
But they're pushing us now to new areas,
thinking about if we're a community,
if their family members show up to our
ER and they bring them in. They wanna
make sure that we're we're doing the same
for every member of the community we would
do with their family. So they keep telling
us new pieces of this kinda learning health
pathway that we need to get better with.
Yeah. I mean, fantastic,
story, fantastic results. So greatly appreciate
and so greatly respect,
the work that you and your your fantastic
clinical teams are doing across the board.
Last question, doctor Thomas, before I let you
go, I think for any other clinical leaders
listening to the podcast, physician leaders, teams at
hospitals, health centers across the country
looking to achieve similar success in terms of
improving sepsis care across their organizations,
is there one or two maybe key pieces
of advice that you give them?
Yeah. I think,
number one is,
your teams and their talent are critical. Use
them.
Listen to their feedback.
Go to where they do their work
and get their ideas.
That for us was revolutionary.
It changed us from an old way of
thinking to a new way of thinking. After
you get their opinion,
be willing to do things that are innovative
that others would say,
has not been done before,
like like we have and find partners who
are willing to do it differently. Our partner
here,
was a a company that makes this test
called Intelycep.
We were brave enough, I think, from our
team to say we wanna use a novel
diagnostic be better. And so for other health
system leaders, my recommendation is,
sometimes the courage is in changing something that
was already working to try to get to
Elite.
And then with the way technology is developing,
be willing to seek out new personalized kind
of tests. This test that we use,
looks at the actual
biology
of the individual patient you're looking at, which
is a revolutionary
change from just an aggregate
of vitals and maybe a little bit of
history.
So for health system leaders, be willing to
take what you do really, really now and
go to a version two point o
or do that thing that we call the
pivot. Pivot with your people and your process
and add something in that you think is
gonna have really good patient centered goals.
And then be willing to tell your teams
what is and is not working
because you can essentially
supersize your results, and I think you can
escalate
and accelerate
the process of improvement
over a shorter timeline. And that's what we're
here to do from a health care perspective.
I think some fantastic
words of wisdom, key takeaways, and advice for
any of our clinical leaders here as we
round out our discussion.
Doctor Thomas, so greatly appreciate you taking the
time out of your busy schedule. Really, really
enjoyed this conversation, and I look forward to
connecting with you again down the line.
Absolutely. Thank you so much for having me.