1 00:00:00,240 --> 00:00:03,220 This is Alan Connan with the Becker's Healthcare 2 00:00:03,359 --> 00:00:06,160 Podcast. And today, I'm delighted to be joined 3 00:00:06,160 --> 00:00:09,679 by doctor Christopher Thomas, vice president and chief 4 00:00:09,679 --> 00:00:13,199 quality officer of Franciscan Missionaries of Our Lady 5 00:00:13,199 --> 00:00:15,460 Health System. That's a 10 hospital 6 00:00:15,974 --> 00:00:17,835 nonprofit health system headquartered 7 00:00:18,135 --> 00:00:19,754 in Baton Rouge, Louisiana. 8 00:00:20,295 --> 00:00:22,375 Doctor Thomas, pleasure to have you on the 9 00:00:22,375 --> 00:00:24,535 podcast with us today. Before we dive into 10 00:00:24,535 --> 00:00:26,695 our discussion, I'd love to just firstly hand 11 00:00:26,695 --> 00:00:28,454 the hand the floor over to you, hear 12 00:00:28,454 --> 00:00:30,375 a little bit more about your background and 13 00:00:30,375 --> 00:00:31,679 your role at the health system. 14 00:00:32,719 --> 00:00:34,179 Yeah. Happy to be on. 15 00:00:34,799 --> 00:00:37,859 I am a pulmonary and critical care physician 16 00:00:38,000 --> 00:00:38,899 by training. 17 00:00:39,840 --> 00:00:41,060 Moved into that 18 00:00:41,440 --> 00:00:44,079 area because I was concerned and wanted to 19 00:00:44,079 --> 00:00:47,475 kinda investigate critical illness, and and that's how 20 00:00:47,475 --> 00:00:48,774 I ended up in sepsis. 21 00:00:49,635 --> 00:00:51,155 I grew up in a small town in 22 00:00:51,155 --> 00:00:51,975 West Virginia. 23 00:00:52,594 --> 00:00:54,914 And then when I joined our health system 24 00:00:54,914 --> 00:00:57,335 here, was afforded the opportunity to think about 25 00:00:57,554 --> 00:00:58,695 safety at scale 26 00:00:59,240 --> 00:01:01,320 and how we can improve the overall outcome 27 00:01:01,320 --> 00:01:02,780 of many patients. So, 28 00:01:03,159 --> 00:01:05,659 moved into the role of chief quality officer, 29 00:01:06,280 --> 00:01:08,939 after a stint as medical director of system 30 00:01:09,000 --> 00:01:10,379 quality and patient safety 31 00:01:10,680 --> 00:01:12,620 over the last three to four years. 32 00:01:13,354 --> 00:01:15,915 That's been kind of a journey of moving 33 00:01:15,915 --> 00:01:18,814 from the research elements over to the application 34 00:01:18,875 --> 00:01:21,194 of evidence based medicine, which for us is 35 00:01:21,194 --> 00:01:23,834 quality and trying to bridge the gap in 36 00:01:23,834 --> 00:01:24,334 between 37 00:01:24,795 --> 00:01:27,134 a publication that says we should do 38 00:01:27,579 --> 00:01:29,819 a certain intervention for patients and then the 39 00:01:29,819 --> 00:01:32,140 time it takes us to get every patient 40 00:01:32,140 --> 00:01:34,619 within our health system to be able to 41 00:01:34,619 --> 00:01:35,759 realize those benefits. 42 00:01:37,019 --> 00:01:38,939 Got it. And I really appreciate the the 43 00:01:38,939 --> 00:01:41,180 brief kind of background and perspective there. And 44 00:01:41,180 --> 00:01:41,840 I understand 45 00:01:42,395 --> 00:01:44,314 big, big core part of your focus. Like 46 00:01:44,314 --> 00:01:46,314 you said, moving from that research to the 47 00:01:46,314 --> 00:01:46,814 application 48 00:01:47,275 --> 00:01:48,814 of evidence based medicine, 49 00:01:49,275 --> 00:01:51,755 and I understand you you recently led a 50 00:01:51,755 --> 00:01:53,775 a landmark initiative that achieved 51 00:01:54,314 --> 00:01:57,055 a thirty nine percent reduction in sepsis 52 00:01:57,640 --> 00:02:00,359 mortality at the health system. I'm eager and 53 00:02:00,359 --> 00:02:02,680 excited to hear more about this significant achievement. 54 00:02:02,680 --> 00:02:03,180 So 55 00:02:03,480 --> 00:02:05,880 to kick things off, could you begin by 56 00:02:05,880 --> 00:02:07,020 walking us through 57 00:02:07,480 --> 00:02:09,560 the moment that you realized that this was 58 00:02:09,560 --> 00:02:12,040 a critical issue that your health system needed 59 00:02:12,040 --> 00:02:12,699 to tackle? 60 00:02:13,775 --> 00:02:16,575 When we look at the major reasons patients 61 00:02:16,575 --> 00:02:17,795 come in the hospitals 62 00:02:18,335 --> 00:02:21,855 and when they leave hospitals, they don't return 63 00:02:21,855 --> 00:02:24,014 to the same level of function to their 64 00:02:24,014 --> 00:02:26,415 families. The disease that we become the most 65 00:02:26,415 --> 00:02:27,715 concerned with is sepsis. 66 00:02:28,189 --> 00:02:30,030 So as we began to evaluate how do 67 00:02:30,030 --> 00:02:31,710 we think of all of the patients who 68 00:02:31,710 --> 00:02:33,469 are coming into our health system and what's 69 00:02:33,469 --> 00:02:35,090 the most impactful disease 70 00:02:35,389 --> 00:02:37,550 that would get patients back to their dinner 71 00:02:37,550 --> 00:02:39,250 tables and get them to living, 72 00:02:40,270 --> 00:02:42,590 we decided this was the one. If you 73 00:02:42,590 --> 00:02:45,754 ask me retrospectively whether that was a great 74 00:02:45,754 --> 00:02:47,114 decision, I would tell you, 75 00:02:47,435 --> 00:02:49,194 I probably should have started in something that 76 00:02:49,194 --> 00:02:50,014 was easier. 77 00:02:50,474 --> 00:02:52,814 But globally for us, when you, 78 00:02:53,194 --> 00:02:55,354 come off of the pandemic, what you're really 79 00:02:55,354 --> 00:02:58,014 trying to understand is patients have a risk 80 00:02:58,099 --> 00:02:59,480 to develop an infection. 81 00:02:59,939 --> 00:03:01,939 And then when they develop an infection, the 82 00:03:01,939 --> 00:03:03,639 body either responds appropriately 83 00:03:04,020 --> 00:03:06,680 or it responds in an abnormal way and 84 00:03:07,300 --> 00:03:09,780 and creates this area where all of the 85 00:03:09,780 --> 00:03:12,040 organs respond to the presence of infection. 86 00:03:12,884 --> 00:03:15,284 We were really interested in that the majority 87 00:03:15,284 --> 00:03:17,064 of people who show up to the ER 88 00:03:17,365 --> 00:03:18,584 have an infection. 89 00:03:19,125 --> 00:03:20,805 And if they have an infection in that 90 00:03:20,805 --> 00:03:22,645 group, who is going to be those who 91 00:03:22,645 --> 00:03:24,485 get really sick, and who are gonna be 92 00:03:24,485 --> 00:03:25,865 those that we can say, 93 00:03:26,169 --> 00:03:27,769 I think you're okay for right now and 94 00:03:27,769 --> 00:03:28,830 you can go home. 95 00:03:29,209 --> 00:03:31,530 So in taking care of our communities that 96 00:03:31,530 --> 00:03:33,949 we're privileged to serve, it was the disease 97 00:03:34,009 --> 00:03:34,509 that 98 00:03:34,810 --> 00:03:37,689 came to our our forefront and said, if 99 00:03:37,689 --> 00:03:39,069 we're gonna be really good 100 00:03:39,504 --> 00:03:41,764 for our hospitals in Louisiana and Mississippi, 101 00:03:42,064 --> 00:03:43,585 we need to be really good at this 102 00:03:43,585 --> 00:03:45,344 disease, and that's kind of when we first 103 00:03:45,344 --> 00:03:47,185 started to look at it. From a personal 104 00:03:47,185 --> 00:03:47,685 journey, 105 00:03:48,625 --> 00:03:50,884 I actually experienced this with my father. 106 00:03:51,870 --> 00:03:53,569 And so it's always been a personal, 107 00:03:54,509 --> 00:03:55,009 evaluation 108 00:03:55,310 --> 00:03:58,030 of, hey. He had a routine procedure. He 109 00:03:58,030 --> 00:04:00,430 got an infection, and then he became critically 110 00:04:00,430 --> 00:04:03,229 ill. And so I began to think before 111 00:04:03,229 --> 00:04:05,550 I ever joined our health system, what would 112 00:04:05,550 --> 00:04:08,014 that be like if it wasn't my dad, 113 00:04:08,014 --> 00:04:10,415 but it was someone else's family? And could 114 00:04:10,415 --> 00:04:12,814 I be confident as the quality officer for 115 00:04:12,814 --> 00:04:15,615 us that every single time, every single patient 116 00:04:15,615 --> 00:04:17,694 would get the same approach and get the 117 00:04:17,694 --> 00:04:20,035 same results that he was fortunate to have 118 00:04:20,574 --> 00:04:22,355 when I was in medical school? 119 00:04:23,699 --> 00:04:26,419 I'm curious to just follow-up. And out of 120 00:04:26,419 --> 00:04:29,160 those patients that present to the emergency department, 121 00:04:29,459 --> 00:04:31,399 can you talk us a little bit about 122 00:04:31,459 --> 00:04:32,439 how you identify 123 00:04:32,979 --> 00:04:35,620 those patients with infections that were going to 124 00:04:35,620 --> 00:04:37,814 be really sick and and needed to be 125 00:04:37,814 --> 00:04:40,055 treated and stayed perhaps in the hospital, and 126 00:04:40,055 --> 00:04:42,935 those patients who presented in the ED with 127 00:04:42,935 --> 00:04:45,414 an infection but were perhaps healthy and strong 128 00:04:45,414 --> 00:04:47,414 enough to fight that infection and maybe return 129 00:04:47,414 --> 00:04:47,914 home. 130 00:04:48,860 --> 00:04:51,339 Yeah. This is a fantastic question and one 131 00:04:51,339 --> 00:04:54,220 that's really critical across The United States. There 132 00:04:54,220 --> 00:04:55,279 are many diseases 133 00:04:55,819 --> 00:04:57,279 where we're very clear 134 00:04:57,660 --> 00:05:00,379 the severity of illness related to the test 135 00:05:00,379 --> 00:05:02,079 that we have. So, 136 00:05:02,535 --> 00:05:04,455 for example, if you come in with chest 137 00:05:04,455 --> 00:05:06,855 pain and you have a very specific change 138 00:05:06,855 --> 00:05:07,835 on your EKG, 139 00:05:08,375 --> 00:05:11,035 something that we call a ST elevation myocardial 140 00:05:11,175 --> 00:05:13,735 infarction, we take you immediately to the cath 141 00:05:13,735 --> 00:05:16,019 lab. And we know that the patients who 142 00:05:16,019 --> 00:05:18,439 do not have that specific change 143 00:05:18,980 --> 00:05:21,379 won't have a severity of an illness as 144 00:05:21,379 --> 00:05:23,879 that patient. We know that in stroke care 145 00:05:24,019 --> 00:05:25,379 that when you come in and we get 146 00:05:25,379 --> 00:05:27,240 a CAT scan and we see a blockage 147 00:05:27,334 --> 00:05:29,175 in a vessel in your brain, that we 148 00:05:29,175 --> 00:05:31,254 need to be able in our comprehensive stroke 149 00:05:31,254 --> 00:05:33,514 centers to go and get that clot out. 150 00:05:33,895 --> 00:05:36,295 For us in sepsis up to about three 151 00:05:36,295 --> 00:05:38,235 years ago when we began this journey, 152 00:05:38,615 --> 00:05:40,375 what I would tell you is we just 153 00:05:40,375 --> 00:05:41,675 were forced to assume 154 00:05:42,055 --> 00:05:42,795 that everyone 155 00:05:43,279 --> 00:05:45,759 who had an infection was at risk to 156 00:05:45,759 --> 00:05:46,259 develop, 157 00:05:47,040 --> 00:05:50,080 an abnormal response and get markedly sicker. And 158 00:05:50,080 --> 00:05:51,699 so we, by definition, 159 00:05:52,080 --> 00:05:52,580 overtreated 160 00:05:53,040 --> 00:05:54,720 all the patients. So you brought up a 161 00:05:54,720 --> 00:05:57,115 really great point. That meant that there were 162 00:05:57,115 --> 00:05:59,294 people who we watched in the hospital 163 00:05:59,675 --> 00:06:01,995 who probably were able to go home and 164 00:06:01,995 --> 00:06:03,915 then on the other side of it, you 165 00:06:03,915 --> 00:06:05,055 had to be perfect 166 00:06:05,435 --> 00:06:07,274 in your assessment of who were the ones 167 00:06:07,274 --> 00:06:09,675 that were gonna get sick. And it was 168 00:06:09,675 --> 00:06:11,854 less elite than our 169 00:06:12,209 --> 00:06:15,329 management of things like trauma and heart attack 170 00:06:15,329 --> 00:06:17,730 and stroke. It just didn't meet the same 171 00:06:17,730 --> 00:06:19,490 standard of where we were trying to go 172 00:06:19,490 --> 00:06:20,870 from an excellence perspective. 173 00:06:21,170 --> 00:06:23,089 So that was the very first question we 174 00:06:23,089 --> 00:06:25,329 looked at is, what do we need? How 175 00:06:25,329 --> 00:06:26,949 do we create a structure 176 00:06:27,345 --> 00:06:30,564 that takes those patients who, as you described, 177 00:06:30,944 --> 00:06:33,185 some could go home and some are gonna 178 00:06:33,185 --> 00:06:35,425 get really sick, and how do we figure 179 00:06:35,425 --> 00:06:37,985 out who is who? And that led us 180 00:06:37,985 --> 00:06:40,084 to both the research and then implementation 181 00:06:40,944 --> 00:06:43,045 of a new diagnostic test, 182 00:06:43,639 --> 00:06:45,960 that was developed. It's brought by a company 183 00:06:45,960 --> 00:06:48,360 called CytoVAIL and Intelycep. And so it was 184 00:06:48,360 --> 00:06:51,240 a key feature for us in creating this 185 00:06:51,240 --> 00:06:51,740 pathway 186 00:06:52,120 --> 00:06:53,800 to being able to pick out the right 187 00:06:53,800 --> 00:06:56,360 patient at the right time as opposed to 188 00:06:56,360 --> 00:06:58,460 all of the patients getting everything. 189 00:06:59,485 --> 00:07:01,164 Got it. And that makes a ton of 190 00:07:01,164 --> 00:07:02,845 sense. It was kind of the first question 191 00:07:02,845 --> 00:07:04,524 that's sprung into my mind when I when 192 00:07:04,524 --> 00:07:06,204 I was reading about this study and this 193 00:07:06,204 --> 00:07:08,485 this significant achievement on your part and by 194 00:07:08,485 --> 00:07:10,044 the everyone at your team with the health 195 00:07:10,044 --> 00:07:12,845 system. Ties right into my next question, which 196 00:07:12,845 --> 00:07:15,060 I wanted to to pry on. What were 197 00:07:15,060 --> 00:07:18,839 the biggest gaps in sepsis triage and management 198 00:07:19,139 --> 00:07:21,720 that you identified early in the process, particularly, 199 00:07:21,939 --> 00:07:23,800 like we said, in the emergency department? 200 00:07:24,819 --> 00:07:26,819 Yeah. I think we didn't use our talent 201 00:07:26,819 --> 00:07:29,235 well, to be honest, and this is a 202 00:07:29,314 --> 00:07:32,214 a challenge across The United States. We had 203 00:07:32,274 --> 00:07:34,834 experts in being able to suspect people of 204 00:07:34,834 --> 00:07:37,574 having infections. That was our nurse triage team. 205 00:07:37,634 --> 00:07:39,875 We weren't using them and giving them tools 206 00:07:39,875 --> 00:07:41,714 in a way that could be repeatable in 207 00:07:41,714 --> 00:07:42,854 every single time. 208 00:07:43,209 --> 00:07:45,129 So that was the first step. The second 209 00:07:45,129 --> 00:07:46,729 step is we needed to listen to our 210 00:07:46,729 --> 00:07:48,509 teams who said, hey. There are 211 00:07:48,970 --> 00:07:51,129 procedures that we wanna do to patients to 212 00:07:51,129 --> 00:07:52,889 help them, and then there are procedures we're 213 00:07:52,889 --> 00:07:55,129 doing the patients that don't help them. That 214 00:07:55,129 --> 00:07:57,404 was something called blood cultures. So we listened 215 00:07:57,404 --> 00:07:59,485 to our phlebotomy team and our nurses to 216 00:07:59,485 --> 00:08:01,964 kind of start a process that started with 217 00:08:01,964 --> 00:08:04,225 the nurses and then nurse initiated or set, 218 00:08:04,605 --> 00:08:07,084 and then develop a set of labs that 219 00:08:07,084 --> 00:08:09,084 told us who was at high risk and 220 00:08:09,084 --> 00:08:11,459 who was not. And that new addition in 221 00:08:11,459 --> 00:08:14,099 that triage is that's where the Intelycep test 222 00:08:14,099 --> 00:08:16,899 for us became super helpful. It allowed us 223 00:08:16,899 --> 00:08:18,899 to change to look at the patients and 224 00:08:18,899 --> 00:08:21,379 say, you are very sick, and we're gonna 225 00:08:21,379 --> 00:08:23,620 come give you as much treatment early as 226 00:08:23,620 --> 00:08:25,595 possible. And then it allowed us to look 227 00:08:25,595 --> 00:08:26,415 at the patients 228 00:08:26,875 --> 00:08:29,435 where it was very clear over ninety seven 229 00:08:29,435 --> 00:08:30,795 to ninety eight percent of the time, they 230 00:08:30,795 --> 00:08:33,115 were not gonna progress to this threatening thing 231 00:08:33,115 --> 00:08:35,674 that we call sepsis and allow us to 232 00:08:35,674 --> 00:08:39,230 treat them in an individual manner, personalized still, 233 00:08:39,370 --> 00:08:41,529 but not expose them to all of the 234 00:08:41,529 --> 00:08:43,850 testing and all of the procedures that are 235 00:08:43,850 --> 00:08:46,750 necessary when the patients are really critically ill. 236 00:08:47,129 --> 00:08:47,629 So, 237 00:08:48,330 --> 00:08:51,085 the take home from that is triage had 238 00:08:51,085 --> 00:08:52,065 to be optimized, 239 00:08:52,605 --> 00:08:54,125 and then we had to have a pathway 240 00:08:54,125 --> 00:08:55,804 where we could get to something that told 241 00:08:55,804 --> 00:08:58,065 us you're gonna get sick or you're not, 242 00:08:58,205 --> 00:09:00,779 and then allow our teams of just elite, 243 00:09:01,180 --> 00:09:02,720 emergency department physicians 244 00:09:03,100 --> 00:09:05,500 who they're gonna go to the first and 245 00:09:05,500 --> 00:09:07,920 get to the amount of treatment that's necessary 246 00:09:07,980 --> 00:09:09,360 in terms of antibiotics 247 00:09:10,139 --> 00:09:12,220 and then evaluating them and having a good 248 00:09:12,220 --> 00:09:14,460 conversation with their families about how concerned we 249 00:09:14,460 --> 00:09:15,440 are about them. 250 00:09:16,174 --> 00:09:18,014 Curious if you could just talk one bit 251 00:09:18,014 --> 00:09:18,995 more about 252 00:09:19,375 --> 00:09:21,074 rallying at at the talent, 253 00:09:21,454 --> 00:09:23,634 the staff, the clinicians at your organization, 254 00:09:24,014 --> 00:09:26,254 kind of what you did specifically differently in 255 00:09:26,254 --> 00:09:28,095 terms of the tools you provided them, the 256 00:09:28,095 --> 00:09:30,814 resources, perhaps the education to really kinda really 257 00:09:30,814 --> 00:09:33,120 help secure that buy in and drive towards 258 00:09:33,120 --> 00:09:33,940 these results? 259 00:09:34,879 --> 00:09:37,679 Yeah. We have a phenomenal performance improvement team, 260 00:09:37,919 --> 00:09:39,360 here at Our Lady of Lake Health and 261 00:09:39,360 --> 00:09:41,519 as part of the system. And the first 262 00:09:41,519 --> 00:09:43,360 thing we did was took the voice of 263 00:09:43,360 --> 00:09:43,860 those, 264 00:09:44,534 --> 00:09:47,335 team members who said, we wanna get several 265 00:09:47,335 --> 00:09:48,315 things correct. 266 00:09:48,855 --> 00:09:51,335 We wanna make sure that we get into 267 00:09:51,335 --> 00:09:53,575 the waiting room and pull out patients who 268 00:09:53,575 --> 00:09:55,815 are sick, who may not look really sick. 269 00:09:55,815 --> 00:09:58,000 We wanna make sure that we have this 270 00:09:58,000 --> 00:10:00,480 correct recognition of the patients who do have 271 00:10:00,480 --> 00:10:00,980 sepsis. 272 00:10:01,440 --> 00:10:03,120 We wanna make sure that the patients were 273 00:10:03,120 --> 00:10:04,019 taken care of, 274 00:10:04,480 --> 00:10:06,480 stay in the hospital for a very short 275 00:10:06,480 --> 00:10:08,639 period of time or shorter compared to others. 276 00:10:08,639 --> 00:10:10,480 We wanna make sure that they are able 277 00:10:10,480 --> 00:10:11,139 to survive. 278 00:10:11,919 --> 00:10:12,579 And then 279 00:10:12,924 --> 00:10:15,085 the teams also told us a really interesting 280 00:10:15,085 --> 00:10:17,325 concept that's critical to this is they also 281 00:10:17,325 --> 00:10:17,825 said, 282 00:10:18,285 --> 00:10:20,205 we also wanna look at the patients who 283 00:10:20,205 --> 00:10:22,684 before we thought were septic but are really 284 00:10:22,684 --> 00:10:25,085 sick and who aren't septic. And we wanna 285 00:10:25,085 --> 00:10:27,360 have a pathway where we can pivot off 286 00:10:27,360 --> 00:10:29,879 of them. So we call this people process 287 00:10:29,879 --> 00:10:31,799 and pivot. We took the talent of the 288 00:10:31,799 --> 00:10:34,460 people. That's the ER, the phlebotomist, the pharmacist, 289 00:10:34,519 --> 00:10:36,679 our performance improvement team. We put them in 290 00:10:36,679 --> 00:10:38,220 a room every week, 291 00:10:38,600 --> 00:10:40,759 and we looked at every single result over 292 00:10:40,759 --> 00:10:44,384 an entire year and continued to iteratively improve 293 00:10:44,924 --> 00:10:47,164 the process that we were creating. We let 294 00:10:47,164 --> 00:10:49,644 them tell us what was working and what 295 00:10:49,644 --> 00:10:51,404 wasn't working, and so we could get to, 296 00:10:51,404 --> 00:10:53,804 like, a final really good structure that you 297 00:10:53,804 --> 00:10:56,279 see in those results of the reduction in 298 00:10:56,440 --> 00:10:59,019 in mortality relative by thirty nine percent, 299 00:10:59,560 --> 00:11:01,720 a length of stay reduction of point seven 300 00:11:01,720 --> 00:11:02,220 six. 301 00:11:02,680 --> 00:11:05,320 But more specifically, when you put those people 302 00:11:05,320 --> 00:11:07,500 together in a room in performance improvement, 303 00:11:08,120 --> 00:11:10,460 they then begin to drive the change 304 00:11:11,095 --> 00:11:14,215 related to other things surrounding the disease. And 305 00:11:14,215 --> 00:11:15,975 so what we learned is that they were 306 00:11:15,975 --> 00:11:18,375 much more comfortable in having the conversation about 307 00:11:18,375 --> 00:11:20,855 sepsis with the patients. They were able to 308 00:11:20,855 --> 00:11:21,355 enhance 309 00:11:21,815 --> 00:11:24,075 the conversation about risk with the patients. 310 00:11:24,535 --> 00:11:27,330 And so the biggest part about this is 311 00:11:27,330 --> 00:11:30,389 the ability to implement a really novel diagnostic, 312 00:11:30,610 --> 00:11:32,950 but at the same time, kind of 313 00:11:33,410 --> 00:11:35,830 estimate the talent of your internal team, 314 00:11:36,290 --> 00:11:39,330 recognize when they're really supremely talented, and then 315 00:11:39,330 --> 00:11:41,375 put them into a process and a structure 316 00:11:41,375 --> 00:11:43,134 where they can show that talent. And that's 317 00:11:43,134 --> 00:11:45,455 what we've been able to do, not only 318 00:11:45,455 --> 00:11:48,335 for where the first pilot location in The 319 00:11:48,335 --> 00:11:50,735 United States was of this process, our Lady 320 00:11:50,735 --> 00:11:52,575 of the Lake Regional Medical Center in Baton 321 00:11:52,575 --> 00:11:55,294 Rouge, but now in the rest of our 322 00:11:55,294 --> 00:11:58,319 health system to repeat and replicate that kind 323 00:11:58,319 --> 00:12:00,659 of process. And so it's been really rewarding. 324 00:12:01,199 --> 00:12:04,639 Fantastic. The the three p's, people, process, and 325 00:12:04,639 --> 00:12:06,100 pivot. Love that. 326 00:12:06,959 --> 00:12:09,665 Obviously, the results really speak for themselves. I 327 00:12:09,665 --> 00:12:11,745 mean, hats off to to you and the 328 00:12:11,745 --> 00:12:13,445 fantastic team around you. 329 00:12:14,304 --> 00:12:16,304 What are the next steps? And in terms 330 00:12:16,304 --> 00:12:19,764 of driving even further, even more substantial results 331 00:12:19,825 --> 00:12:21,825 results around sepsis, how are you looking to 332 00:12:21,825 --> 00:12:23,424 continue the great work that you're doing across 333 00:12:23,424 --> 00:12:24,325 the health system? 334 00:12:25,000 --> 00:12:26,759 Yeah. I think this just comes back to 335 00:12:26,759 --> 00:12:28,600 listening to the team. So here's what they've 336 00:12:28,600 --> 00:12:31,899 told us. Before we started this process versus 337 00:12:31,959 --> 00:12:34,839 after, the after process for every a hundred 338 00:12:34,839 --> 00:12:37,259 and ten patients we put through this structure, 339 00:12:37,559 --> 00:12:38,745 we save one life. 340 00:12:39,225 --> 00:12:40,024 For every patient, 341 00:12:41,464 --> 00:12:41,964 comparatively 342 00:12:42,745 --> 00:12:45,384 from before and after who comes up with 343 00:12:45,384 --> 00:12:47,004 a high risk test, 344 00:12:47,945 --> 00:12:50,904 we save it takes about 24 of those 345 00:12:50,904 --> 00:12:53,590 tests. So the number needed to treat based 346 00:12:53,590 --> 00:12:55,769 on that high risk result is twenty four. 347 00:12:56,470 --> 00:12:59,590 So we're taking those numbers and we're saying 348 00:12:59,590 --> 00:13:02,629 where else in this journey of the pathway 349 00:13:02,629 --> 00:13:03,929 of the sepsis patient 350 00:13:04,309 --> 00:13:07,110 can we help further improve the care? So 351 00:13:07,110 --> 00:13:11,125 we're now looking at how our antibiotic use 352 00:13:11,125 --> 00:13:13,764 and which antibiotics that we're using, how can 353 00:13:13,764 --> 00:13:16,485 we optimize that. Meaning, if you don't need 354 00:13:16,485 --> 00:13:19,205 a very broad antibiotic, let's not give it 355 00:13:19,205 --> 00:13:21,705 to you. Let's be very specific and tailored. 356 00:13:22,350 --> 00:13:24,750 We're also beginning to look at, well, what 357 00:13:24,990 --> 00:13:27,070 who are those patients that we think we're 358 00:13:27,070 --> 00:13:28,990 gonna need to admit to the hospital, but 359 00:13:28,990 --> 00:13:31,309 the next twenty four hours to thirty six 360 00:13:31,309 --> 00:13:33,470 hours is gonna dictate to us whether you're 361 00:13:33,470 --> 00:13:35,549 gonna potentially get sicker or whether you're gonna 362 00:13:35,549 --> 00:13:38,014 get to go home. So we're focusing in 363 00:13:38,014 --> 00:13:40,254 on them. That's for us a process that 364 00:13:40,254 --> 00:13:43,214 we call rescuing the patient. So recognizing the 365 00:13:43,214 --> 00:13:45,454 disease and making sure that if they were 366 00:13:45,454 --> 00:13:47,534 gonna get sicker, we have to think about 367 00:13:47,534 --> 00:13:48,195 the rescue. 368 00:13:48,654 --> 00:13:49,315 And then 369 00:13:49,799 --> 00:13:52,440 on the last part, this is also about 370 00:13:52,440 --> 00:13:55,960 adding other data to this this new novel 371 00:13:55,960 --> 00:13:57,960 way to look at sepsis. So if I 372 00:13:57,960 --> 00:14:00,379 have my dad who would have come in 373 00:14:00,679 --> 00:14:03,639 and he talks to our emergency department team 374 00:14:03,639 --> 00:14:05,534 and they triage him, and then he gets 375 00:14:05,534 --> 00:14:07,375 the test and the test says he's high 376 00:14:07,375 --> 00:14:09,454 risk. And then as we think about him 377 00:14:09,454 --> 00:14:10,514 being high risk, 378 00:14:10,815 --> 00:14:13,454 what are the other things that we need 379 00:14:13,454 --> 00:14:15,534 to do for him to ensure that he 380 00:14:15,534 --> 00:14:18,095 gets to go home? And so adding things 381 00:14:18,095 --> 00:14:21,054 like a structured mobility program because we know 382 00:14:21,054 --> 00:14:23,990 sepsis patients get weaker which we have. And 383 00:14:23,990 --> 00:14:25,830 let's then look about what his needs are 384 00:14:25,830 --> 00:14:28,230 gonna be two and three days later so 385 00:14:28,230 --> 00:14:30,070 that when he's discharged, we wanna make sure 386 00:14:30,070 --> 00:14:32,149 that he understands the disease he had and 387 00:14:32,149 --> 00:14:34,090 that he sees his primary care physician 388 00:14:34,470 --> 00:14:36,169 within the next seven days. 389 00:14:36,554 --> 00:14:38,654 So really thinking about this holistically, 390 00:14:39,034 --> 00:14:41,375 this process looked about the inpatient 391 00:14:42,154 --> 00:14:45,455 ability to triage and identify a sepsis patient. 392 00:14:45,754 --> 00:14:47,855 And now as you take a step back, 393 00:14:48,154 --> 00:14:50,970 what we've begun to really think is we're 394 00:14:51,209 --> 00:14:53,529 world class in the results and recognition, and 395 00:14:53,529 --> 00:14:56,250 we're world class in the results of treatment, 396 00:14:56,250 --> 00:14:58,350 but we'd like to be world class 397 00:14:58,809 --> 00:15:00,970 in preventing you from ever needing to come 398 00:15:00,970 --> 00:15:03,209 into the hospital. And then if you had 399 00:15:03,209 --> 00:15:05,485 to, if it was unfortunate enough that you 400 00:15:05,485 --> 00:15:07,425 get infection and you get sepsis, 401 00:15:08,045 --> 00:15:10,285 what are we doing on the backside that's 402 00:15:10,285 --> 00:15:12,684 really meaningful in the same results that we've 403 00:15:12,684 --> 00:15:13,504 seen here? 404 00:15:14,045 --> 00:15:16,384 Sometimes we think meaning is just, 405 00:15:17,085 --> 00:15:19,165 checking a box to do something. What our 406 00:15:19,165 --> 00:15:21,299 teams are pushing us to do is if 407 00:15:21,299 --> 00:15:23,620 we do something, I wanna make sure that 408 00:15:23,620 --> 00:15:24,279 it helps 409 00:15:24,659 --> 00:15:26,039 someone's mother, brother, 410 00:15:26,419 --> 00:15:29,059 you know, sister, father. And so, really just 411 00:15:29,059 --> 00:15:29,799 a congratulations 412 00:15:30,179 --> 00:15:32,200 to the team to continue to push us 413 00:15:32,580 --> 00:15:34,500 in what we do because I think many 414 00:15:34,500 --> 00:15:37,075 places would stop at this level of success 415 00:15:37,075 --> 00:15:39,254 in terms of length of stay and mortality. 416 00:15:39,875 --> 00:15:41,815 But they're pushing us now to new areas, 417 00:15:42,195 --> 00:15:44,774 thinking about if we're a community, 418 00:15:45,075 --> 00:15:47,075 if their family members show up to our 419 00:15:47,075 --> 00:15:49,160 ER and they bring them in. They wanna 420 00:15:49,160 --> 00:15:51,160 make sure that we're we're doing the same 421 00:15:51,160 --> 00:15:52,679 for every member of the community we would 422 00:15:52,679 --> 00:15:54,519 do with their family. So they keep telling 423 00:15:54,519 --> 00:15:56,920 us new pieces of this kinda learning health 424 00:15:56,920 --> 00:15:59,100 pathway that we need to get better with. 425 00:15:59,639 --> 00:16:01,259 Yeah. I mean, fantastic, 426 00:16:01,799 --> 00:16:04,274 story, fantastic results. So greatly appreciate 427 00:16:05,054 --> 00:16:06,355 and so greatly respect, 428 00:16:07,054 --> 00:16:08,914 the work that you and your your fantastic 429 00:16:08,975 --> 00:16:11,235 clinical teams are doing across the board. 430 00:16:11,774 --> 00:16:14,095 Last question, doctor Thomas, before I let you 431 00:16:14,095 --> 00:16:16,815 go, I think for any other clinical leaders 432 00:16:16,815 --> 00:16:19,909 listening to the podcast, physician leaders, teams at 433 00:16:19,909 --> 00:16:21,929 hospitals, health centers across the country 434 00:16:22,470 --> 00:16:25,269 looking to achieve similar success in terms of 435 00:16:25,269 --> 00:16:27,769 improving sepsis care across their organizations, 436 00:16:28,389 --> 00:16:30,230 is there one or two maybe key pieces 437 00:16:30,230 --> 00:16:31,690 of advice that you give them? 438 00:16:32,605 --> 00:16:33,345 Yeah. I think, 439 00:16:34,044 --> 00:16:35,264 number one is, 440 00:16:35,804 --> 00:16:38,605 your teams and their talent are critical. Use 441 00:16:38,605 --> 00:16:39,105 them. 442 00:16:40,044 --> 00:16:41,345 Listen to their feedback. 443 00:16:42,205 --> 00:16:45,029 Go to where they do their work 444 00:16:45,509 --> 00:16:46,810 and get their ideas. 445 00:16:47,190 --> 00:16:48,889 That for us was revolutionary. 446 00:16:49,269 --> 00:16:51,029 It changed us from an old way of 447 00:16:51,029 --> 00:16:53,269 thinking to a new way of thinking. After 448 00:16:53,269 --> 00:16:54,490 you get their opinion, 449 00:16:54,870 --> 00:16:57,129 be willing to do things that are innovative 450 00:16:57,269 --> 00:16:58,730 that others would say, 451 00:16:59,615 --> 00:17:00,995 has not been done before, 452 00:17:01,455 --> 00:17:04,015 like like we have and find partners who 453 00:17:04,015 --> 00:17:06,174 are willing to do it differently. Our partner 454 00:17:06,174 --> 00:17:06,674 here, 455 00:17:07,214 --> 00:17:09,875 was a a company that makes this test 456 00:17:09,934 --> 00:17:10,674 called Intelycep. 457 00:17:11,535 --> 00:17:13,710 We were brave enough, I think, from our 458 00:17:13,789 --> 00:17:16,190 team to say we wanna use a novel 459 00:17:16,190 --> 00:17:18,990 diagnostic be better. And so for other health 460 00:17:18,990 --> 00:17:21,169 system leaders, my recommendation is, 461 00:17:21,630 --> 00:17:24,109 sometimes the courage is in changing something that 462 00:17:24,109 --> 00:17:26,109 was already working to try to get to 463 00:17:26,109 --> 00:17:26,609 Elite. 464 00:17:27,085 --> 00:17:29,904 And then with the way technology is developing, 465 00:17:30,765 --> 00:17:33,644 be willing to seek out new personalized kind 466 00:17:33,644 --> 00:17:35,664 of tests. This test that we use, 467 00:17:36,285 --> 00:17:37,505 looks at the actual 468 00:17:38,205 --> 00:17:38,705 biology 469 00:17:39,019 --> 00:17:41,500 of the individual patient you're looking at, which 470 00:17:41,500 --> 00:17:42,399 is a revolutionary 471 00:17:42,700 --> 00:17:44,559 change from just an aggregate 472 00:17:44,859 --> 00:17:47,019 of vitals and maybe a little bit of 473 00:17:47,019 --> 00:17:47,519 history. 474 00:17:47,899 --> 00:17:49,819 So for health system leaders, be willing to 475 00:17:49,819 --> 00:17:51,819 take what you do really, really now and 476 00:17:51,819 --> 00:17:54,319 go to a version two point o 477 00:17:54,755 --> 00:17:56,275 or do that thing that we call the 478 00:17:56,275 --> 00:17:58,674 pivot. Pivot with your people and your process 479 00:17:58,674 --> 00:18:01,315 and add something in that you think is 480 00:18:01,315 --> 00:18:03,815 gonna have really good patient centered goals. 481 00:18:04,515 --> 00:18:06,595 And then be willing to tell your teams 482 00:18:06,595 --> 00:18:08,134 what is and is not working 483 00:18:08,549 --> 00:18:10,250 because you can essentially 484 00:18:10,870 --> 00:18:13,049 supersize your results, and I think you can 485 00:18:13,190 --> 00:18:13,690 escalate 486 00:18:14,070 --> 00:18:14,890 and accelerate 487 00:18:15,190 --> 00:18:16,650 the process of improvement 488 00:18:17,430 --> 00:18:19,509 over a shorter timeline. And that's what we're 489 00:18:19,509 --> 00:18:21,370 here to do from a health care perspective. 490 00:18:22,214 --> 00:18:23,595 I think some fantastic 491 00:18:23,974 --> 00:18:26,294 words of wisdom, key takeaways, and advice for 492 00:18:26,294 --> 00:18:28,214 any of our clinical leaders here as we 493 00:18:28,214 --> 00:18:29,355 round out our discussion. 494 00:18:29,894 --> 00:18:32,134 Doctor Thomas, so greatly appreciate you taking the 495 00:18:32,134 --> 00:18:34,134 time out of your busy schedule. Really, really 496 00:18:34,134 --> 00:18:36,134 enjoyed this conversation, and I look forward to 497 00:18:36,134 --> 00:18:37,755 connecting with you again down the line. 498 00:18:38,355 --> 00:18:40,455 Absolutely. Thank you so much for having me.