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Hi, everyone. This is Lucas Voss with Becker's

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Healthcare. Thanks so much for tuning into the

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Becker's Healthcare podcast series. Today's episode is brought

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to you by Zebra Technologies and Ambien Clinical

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Analytics.

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Today, we're going to talk about the future

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of sepsis care, building systems that support patients

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and clinicians. And joining me for today's discussion

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is Mary Grace Cox, senior director of clinical

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programs at UAB Medicine.

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Mary Grace, thanks so much for being here

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today. It's great to have you.

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Yes. Thanks for having me.

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Absolutely. I wanna start off with introductions for

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our audience. If you could just kick us

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off, share a little bit about yourself, and

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your work in health care. Yeah. Absolutely.

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So I'm a nurse, by training and have

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been at UAB Medicine for a little over

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fourteen years.

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I started at the bedside caring for oncology

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patients, and then in 2016,

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I moved into the quality space as our

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sepsis coordinator.

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And that's where I really saw how much

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we can impact patients by improving systems, not

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even just at the individual patient level, but,

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really for systems and then supporting those clinicians

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that deliver care.

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And so now I focus on clinical effectiveness

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programs with sepsis being one of the biggest.

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And my role is all about really partnering

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with teams to improve outcomes and making their,

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their day to day work a little bit

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easier too.

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I was going to say, I feel like,

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again, we talk about sepsis quite a bit.

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It it it is one of the most

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pressing challenges in acute care. As you've mentioned,

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it's it's a big part of the conversation

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for everybody.

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From your perspective,

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what have we learned in recent years about

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improving patient outcomes in that space, and and

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what factors are most critical for moving the

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needles when we specifically look at mortality rates?

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Yeah. It's a great question because mortality is

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something that is so challenging to move the

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dial on.

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And for sepsis, it's tricky too because the

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science really hasn't changed that much. You know,

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it's early detection, early treatment,

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the things that we really know. And especially

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our clinicians, they know how to treat sepsis.

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But the real sort of progress

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comes,

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from when we pull together people, so our

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clinicians, our experts in the field,

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and give them good process and technology to

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support that. My colleague, Tim, from Ambient,

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really kind of honed in on that recently.

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And so clinicians bring that expertise.

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The process gives that consistency, and then the

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technology,

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like the Ambient Dart tool sort of ties

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it all together.

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And Dart helps us spot trends and variations

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really quickly so we can sort of adjust

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in real time, and that combination

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is really what's helped us drive down mortality

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in a meaningful way. And so I think,

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you know, if you've worked in the sepsis

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space for a long time, you know that

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there's no smoking gun. There's no one thing

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that says, like, oh, this is gonna fix

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our sepsis problem at whatever organization you're at.

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It's really about designing really good processes and

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systems that support clinicians, and so that's kind

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of what DART helps us to do. And

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DART, by the way, stands for the detection

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and response tool for sepsis.

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And so another kind of thing that DART

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has allowed us to do is, I think,

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kind of driven towards a cultural shift for

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us. Mhmm. We used

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to sort of have to continually campaign

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our, clinicians,

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and really go around and raise awareness and

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do all these kind of things for, you

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know, education.

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And we were educating people who already knew

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how to care for their patients with sepsis,

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and so it really wasn't that effective.

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And so we're able to sort of stop

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continually campaigning

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and drive us more toward that culture of

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continuous readiness,

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where sepsis is not something the clinician has

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to be reminded about. It's just sort of

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embedded into their daily practice.

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And I I once I'm reminded of something

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a colleague once said at a conference that

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said, sepsis will highlight everything that's wrong with

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your organization, which sounds pretty discouraging,

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kind of at face value. But it really

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stuck with me, because it's, you know, it's

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true because it touches so many patients across

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the hospital that you work in. You end

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up uncovering,

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you know, opportunities that are not just tied

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to sepsis itself, but go

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almost like a magnifying glass. You kind of

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see gaps in communication and workflow and breakdowns

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in care coordination. And when you address those

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based on what you see with sepsis patients,

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you kind of benefit the entire organization

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at the same time. Yeah. And I'm so

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glad that we have you on because, again,

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you bring such a such an important perspective

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to this from the nurses' side. Right? From

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from the clinician's perspective to this conversation.

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And you've touched on the technology piece and

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the change management part of it too in

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terms of having those conversations with nurses about

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technology and how it impacts their day and

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how it does influence

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the day to day experience as well. I

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was wondering if you could elaborate a little

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bit on sort of that that clinical innovation

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piece and how it's influenced clinicians,

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but then also what lessons that stand out

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to you from this process when it comes

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to supporting them effectively through technology?

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Yeah. Absolutely. So, I would say

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based on experience

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working clinically and then also based, you know,

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on my experience in the quality space, the

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best kind of technology solution is the kind

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that you do not notice at all. It

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just makes your job smoother. It just runs

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in the background,

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and you don't really know what's supporting you.

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It's just giving you the right information at

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the right time.

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And so, you know, clinicians are really quick

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to tell us when a tool gets in

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their way or they don't like it, and

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I can say that because I'm a clinician.

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And so the fact that we hear very

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little about Dart from our frontline staff is

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a really good sign. You know, no news

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kind of means it's good news. I mean,

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it's working the way that it should. But

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our,

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emergency room, physician advisor for sepsis who, you

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know, knows a lot about sepsis, knows a

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lot about quality, but also is an active

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practicing,

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emergency room doc told me that the thing

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that he likes the most about Dart is

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that it doesn't feel like it's another thing

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to do because it's embedded so well in

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his current workflow. So it's integrated in the

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Cerner, which is the EMR that we use.

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It's integrated into Vocera, which is our clinician

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messaging,

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platform. And then we even have desktop notifications

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that show up,

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that are just kind of those those nudges,

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those reminders that something needs to happen for

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your patient or we need to think about

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something for your patient or new clinical data

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has come,

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has resulted, and we need to to pay

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attention to it. And those insights show up,

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you know, when they're already working, they're already

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at their computer, or they already have their

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handheld device on them. So it felt seamless

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instead of an extra step or an extra

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tool that you have to engage with.

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And I feel like that's that's pretty rare

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feedback when you're working with health care technology.

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So we were we were excited,

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to be able to introduce something like that

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into our organization.

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Yeah. I think the link between usability

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and adoption is really, really key. Right? The

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more usability you have, the better or the

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higher the adoption rate is going to be

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in a lot of cases, which is so

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key. And you mentioned the, the emergency room

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doctor, certainly. Is are there any other stories,

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any other conversations that you've you've heard about

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that that you have with with your staff

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around this too?

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Yeah. It's so funny. So on the inpatient

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setting,

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I think that for our inpatient providers, they

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might have been a little bit more skeptical

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of the process. And so when they get

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a notification, they think, oh, it's just another

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thing. Like, something, you know, that's telling me

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to do something that's not pertinent to my

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patient. And so then we kind of go

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down you know, this tool was designed to

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meet clinicians where they are, tell them what

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they need to know about their patient in

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real time from a sepsis perspective. And and

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once we sort of go through, like, the

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ping pong conversation of, well, what about this

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and what about this? You know, they're able

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to see, like, oh, this tool was designed

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to give me what I need when I

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need it, and I can now trust it.

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And so, you know, I think our emergency

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room physicians

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are able to and maybe it's just the

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nature of, you know, how those patients are

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coming, how they're presenting,

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and they process information in a different way.

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But on the inpatient setting, it took maybe

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a little bit more convincing.

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But once they kind of better understood understood

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the tool and how powerful it was, I

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think that they're able to really trust it

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more,

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and really able to it's really kind of

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helped promote collaboration in a way that we

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weren't able to achieve before we introduced,

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a technical solution to this.

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And it's such a great example because, again,

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it illustrates the importance of change management and

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about having conversations with clinicians about not just,

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hey, here's another tool that you have to

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use now,

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but actually saying, hey, Here's what this can

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do for you, which is so key.

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We started our conversation

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talking about the fact that this is difficult

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to measure. Right? Oftentimes, there's difficulty in determining

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work how can we measure this? How can

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we measure success? Etcetera. And and step one

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performance, again, it's one of those things we're

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trying. There are tries, but it's it's hard.

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It remains hard. What are some of those

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insights that you can share,

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about how health systems can strategically

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approach

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this both from a regulatory perspective, regulatory compliance

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rights, and meaningful patient outcome improvement? What are

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some of the things that you want health

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system leaders to know? Yeah.

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Step one is tough. And anyone anyone that,

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you know, works in health care or works

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in a regulatory or quality knows that step

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one is is extremely challenging.

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One, just from a a conversation perspective, you

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know, a lot of times we can be

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doing really well with mortality. In our case,

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we, you know, saw some really

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significant

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decreases

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in our mortality outcomes, which is overall what

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we're trying to impact. We're trying to save

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lives, but our step one compliance was not

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following suit. And so,

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that tells me that step one is not

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always a reflection of how well you're caring

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for your patients. It's kind of encompassing a

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lot of other things too. And I think

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there's good intentions behind SEP one, but it

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just is really tricky because it is all

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or nothing. You have to pass every single

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piece of every single element, that's required. And

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so,

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in a large particularly because we're a large

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academic medical center, we found that that's been

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extremely challenging.

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You know, we have more than 1,300 beds.

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We discharge,

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almost five thousand patients a year with sepsis.

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And so with that kind of volume,

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we don't have the bandwidth to, you know,

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follow each patient in real time and say,

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make sure that they get this bundle element

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and make sure that we're, you know, document

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documenting this the right way. And so that's

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why we have had to lean so much

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on those good strong processes and tools

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that can be applied at a system level

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that sort of act like a safety net.

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They're kind of just in the background waiting

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to be used and waiting to sort of

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nudge the clinician with the right information at

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the right time.

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And, again, it really comes back to that

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three legged stool of people, process, and technology.

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You know, and Dart being that technology piece

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that gives them feedback and, like, visibility

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into where we are with the bundle without

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adding more work. Because I don't want my

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clinicians

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to be sitting at the bedside thinking, okay.

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I'm waiting for the exact right moment when

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it's when I'm allowed to document the sepsis

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reevaluation note. That's not what I want them

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to be doing. I want them to be

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focusing on patient care. And so by using

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the technology kind of arm of this analogy,

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we're able to think about how to set

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them up to get the right information. Again,

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the right information at the right time to

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the right clinician.

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And so even though our step one compliance

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hasn't risen as fast as our mortality rates

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have fallen, we have been able to avoid

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any value based purchasing penalties this year, which

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is a really big deal, and I know

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that everyone really cares about that.

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But we still wanna, you know, keep getting

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better. And so our goal for for next

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year is to hit 80% compliance, which is

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a tall order. But,

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the good thing is that we have DART

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to kind of help test and refine changes,

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kind of like a sandbox to help us

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test test things out and see what works

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to help us meet that goal.

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So technology in this, because you mentioned Dart,

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again, that's really the critical enabler in being

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able to at least make a step in

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the right direction.

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Yes. Absolutely. And Dart has, is really a

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configurable

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tool. You know, when we first designed

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Dart in our setting, we thought, like, oh,

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clinicians will engage with it this way, and

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this is how we design it. And, you

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know, for anything, once you put it into

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place, it's not gonna work exactly how you

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anticipated. And so being able to sort of

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revisit different ways that our clinicians interact with

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that tool,

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based on real world, you know, examples, we're

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able to say, okay. Our clinicians aren't gonna

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go here to receive this information, but they

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are gonna go to this place. Or they

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don't wanna be notified in this way, but

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they do wanna be notified in this way.

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And so, again, being able to kind of

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push and pull levers with the dart tool

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to be able to meet clinicians where they

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are,

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has been really key,

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in driving success.

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Yeah.

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Mary Grace, thank you again so much for

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all of these insights. This is such an

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incredible conversation. I I wanna turn the floor

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over to you. Anything else that you'd like

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to share? Any final thoughts on this topic?

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Anything else that we we haven't touched on

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that's really important for folks to understand?

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Yeah. I think the the perspective that we've

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taken, which I think has been really effective,

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is to really focus on our frontline staff

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from the quality perspective.

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You know, I think we're all here for

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the patients. That's why we, you know, decided

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to go into health care in the first

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place. But if we sort of back that

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upstream a little bit and focus on supporting

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our clinicians at the bedside who are caring

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for our patients and giving them the tools

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and the workflows that they need, they're able

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to be set up for success and really

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deliver the best care to their patients.

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And, you know, it the DART tool really

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gives us confidence that we're able to, again,

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kinda push and pull up on those levers

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to make sure that we find the right

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combination of things,

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and keep learning learning and adapting to our

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systems, which are changing every day. So Yes.

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Keep up with all that is hard, but,

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we're we're making it through.

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It's building the three legged stool together. Right?

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Yeah.

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That's really, really key. Mary Grace, thanks you

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again for being here today. Thank you for

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your great insights. Fantastic to have you. Yeah.

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Thank you so much, Lucas. And we also

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want to thank our podcast sponsor, Zebra Technologies

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and Ambien Clinical Analytics.

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You could tune into more podcasts from Becker's

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Healthcare by visiting our podcast page at beckershospitalreview.com.