Hi, everyone. This is Lucas Voss with Becker's
Healthcare. Thanks so much for tuning into the
Becker's Healthcare podcast series. Today's episode is brought
to you by Zebra Technologies and Ambien Clinical
Analytics.
Today, we're going to talk about the future
of sepsis care, building systems that support patients
and clinicians. And joining me for today's discussion
is Mary Grace Cox, senior director of clinical
programs at UAB Medicine.
Mary Grace, thanks so much for being here
today. It's great to have you.
Yes. Thanks for having me.
Absolutely. I wanna start off with introductions for
our audience. If you could just kick us
off, share a little bit about yourself, and
your work in health care. Yeah. Absolutely.
So I'm a nurse, by training and have
been at UAB Medicine for a little over
fourteen years.
I started at the bedside caring for oncology
patients, and then in 2016,
I moved into the quality space as our
sepsis coordinator.
And that's where I really saw how much
we can impact patients by improving systems, not
even just at the individual patient level, but,
really for systems and then supporting those clinicians
that deliver care.
And so now I focus on clinical effectiveness
programs with sepsis being one of the biggest.
And my role is all about really partnering
with teams to improve outcomes and making their,
their day to day work a little bit
easier too.
I was going to say, I feel like,
again, we talk about sepsis quite a bit.
It it it is one of the most
pressing challenges in acute care. As you've mentioned,
it's it's a big part of the conversation
for everybody.
From your perspective,
what have we learned in recent years about
improving patient outcomes in that space, and and
what factors are most critical for moving the
needles when we specifically look at mortality rates?
Yeah. It's a great question because mortality is
something that is so challenging to move the
dial on.
And for sepsis, it's tricky too because the
science really hasn't changed that much. You know,
it's early detection, early treatment,
the things that we really know. And especially
our clinicians, they know how to treat sepsis.
But the real sort of progress
comes,
from when we pull together people, so our
clinicians, our experts in the field,
and give them good process and technology to
support that. My colleague, Tim, from Ambient,
really kind of honed in on that recently.
And so clinicians bring that expertise.
The process gives that consistency, and then the
technology,
like the Ambient Dart tool sort of ties
it all together.
And Dart helps us spot trends and variations
really quickly so we can sort of adjust
in real time, and that combination
is really what's helped us drive down mortality
in a meaningful way. And so I think,
you know, if you've worked in the sepsis
space for a long time, you know that
there's no smoking gun. There's no one thing
that says, like, oh, this is gonna fix
our sepsis problem at whatever organization you're at.
It's really about designing really good processes and
systems that support clinicians, and so that's kind
of what DART helps us to do. And
DART, by the way, stands for the detection
and response tool for sepsis.
And so another kind of thing that DART
has allowed us to do is, I think,
kind of driven towards a cultural shift for
us. Mhmm. We used
to sort of have to continually campaign
our, clinicians,
and really go around and raise awareness and
do all these kind of things for, you
know, education.
And we were educating people who already knew
how to care for their patients with sepsis,
and so it really wasn't that effective.
And so we're able to sort of stop
continually campaigning
and drive us more toward that culture of
continuous readiness,
where sepsis is not something the clinician has
to be reminded about. It's just sort of
embedded into their daily practice.
And I I once I'm reminded of something
a colleague once said at a conference that
said, sepsis will highlight everything that's wrong with
your organization, which sounds pretty discouraging,
kind of at face value. But it really
stuck with me, because it's, you know, it's
true because it touches so many patients across
the hospital that you work in. You end
up uncovering,
you know, opportunities that are not just tied
to sepsis itself, but go
almost like a magnifying glass. You kind of
see gaps in communication and workflow and breakdowns
in care coordination. And when you address those
based on what you see with sepsis patients,
you kind of benefit the entire organization
at the same time. Yeah. And I'm so
glad that we have you on because, again,
you bring such a such an important perspective
to this from the nurses' side. Right? From
from the clinician's perspective to this conversation.
And you've touched on the technology piece and
the change management part of it too in
terms of having those conversations with nurses about
technology and how it impacts their day and
how it does influence
the day to day experience as well. I
was wondering if you could elaborate a little
bit on sort of that that clinical innovation
piece and how it's influenced clinicians,
but then also what lessons that stand out
to you from this process when it comes
to supporting them effectively through technology?
Yeah. Absolutely. So, I would say
based on experience
working clinically and then also based, you know,
on my experience in the quality space, the
best kind of technology solution is the kind
that you do not notice at all. It
just makes your job smoother. It just runs
in the background,
and you don't really know what's supporting you.
It's just giving you the right information at
the right time.
And so, you know, clinicians are really quick
to tell us when a tool gets in
their way or they don't like it, and
I can say that because I'm a clinician.
And so the fact that we hear very
little about Dart from our frontline staff is
a really good sign. You know, no news
kind of means it's good news. I mean,
it's working the way that it should. But
our,
emergency room, physician advisor for sepsis who, you
know, knows a lot about sepsis, knows a
lot about quality, but also is an active
practicing,
emergency room doc told me that the thing
that he likes the most about Dart is
that it doesn't feel like it's another thing
to do because it's embedded so well in
his current workflow. So it's integrated in the
Cerner, which is the EMR that we use.
It's integrated into Vocera, which is our clinician
messaging,
platform. And then we even have desktop notifications
that show up,
that are just kind of those those nudges,
those reminders that something needs to happen for
your patient or we need to think about
something for your patient or new clinical data
has come,
has resulted, and we need to to pay
attention to it. And those insights show up,
you know, when they're already working, they're already
at their computer, or they already have their
handheld device on them. So it felt seamless
instead of an extra step or an extra
tool that you have to engage with.
And I feel like that's that's pretty rare
feedback when you're working with health care technology.
So we were we were excited,
to be able to introduce something like that
into our organization.
Yeah. I think the link between usability
and adoption is really, really key. Right? The
more usability you have, the better or the
higher the adoption rate is going to be
in a lot of cases, which is so
key. And you mentioned the, the emergency room
doctor, certainly. Is are there any other stories,
any other conversations that you've you've heard about
that that you have with with your staff
around this too?
Yeah. It's so funny. So on the inpatient
setting,
I think that for our inpatient providers, they
might have been a little bit more skeptical
of the process. And so when they get
a notification, they think, oh, it's just another
thing. Like, something, you know, that's telling me
to do something that's not pertinent to my
patient. And so then we kind of go
down you know, this tool was designed to
meet clinicians where they are, tell them what
they need to know about their patient in
real time from a sepsis perspective. And and
once we sort of go through, like, the
ping pong conversation of, well, what about this
and what about this? You know, they're able
to see, like, oh, this tool was designed
to give me what I need when I
need it, and I can now trust it.
And so, you know, I think our emergency
room physicians
are able to and maybe it's just the
nature of, you know, how those patients are
coming, how they're presenting,
and they process information in a different way.
But on the inpatient setting, it took maybe
a little bit more convincing.
But once they kind of better understood understood
the tool and how powerful it was, I
think that they're able to really trust it
more,
and really able to it's really kind of
helped promote collaboration in a way that we
weren't able to achieve before we introduced,
a technical solution to this.
And it's such a great example because, again,
it illustrates the importance of change management and
about having conversations with clinicians about not just,
hey, here's another tool that you have to
use now,
but actually saying, hey, Here's what this can
do for you, which is so key.
We started our conversation
talking about the fact that this is difficult
to measure. Right? Oftentimes, there's difficulty in determining
work how can we measure this? How can
we measure success? Etcetera. And and step one
performance, again, it's one of those things we're
trying. There are tries, but it's it's hard.
It remains hard. What are some of those
insights that you can share,
about how health systems can strategically
approach
this both from a regulatory perspective, regulatory compliance
rights, and meaningful patient outcome improvement? What are
some of the things that you want health
system leaders to know? Yeah.
Step one is tough. And anyone anyone that,
you know, works in health care or works
in a regulatory or quality knows that step
one is is extremely challenging.
One, just from a a conversation perspective, you
know, a lot of times we can be
doing really well with mortality. In our case,
we, you know, saw some really
significant
decreases
in our mortality outcomes, which is overall what
we're trying to impact. We're trying to save
lives, but our step one compliance was not
following suit. And so,
that tells me that step one is not
always a reflection of how well you're caring
for your patients. It's kind of encompassing a
lot of other things too. And I think
there's good intentions behind SEP one, but it
just is really tricky because it is all
or nothing. You have to pass every single
piece of every single element, that's required. And
so,
in a large particularly because we're a large
academic medical center, we found that that's been
extremely challenging.
You know, we have more than 1,300 beds.
We discharge,
almost five thousand patients a year with sepsis.
And so with that kind of volume,
we don't have the bandwidth to, you know,
follow each patient in real time and say,
make sure that they get this bundle element
and make sure that we're, you know, document
documenting this the right way. And so that's
why we have had to lean so much
on those good strong processes and tools
that can be applied at a system level
that sort of act like a safety net.
They're kind of just in the background waiting
to be used and waiting to sort of
nudge the clinician with the right information at
the right time.
And, again, it really comes back to that
three legged stool of people, process, and technology.
You know, and Dart being that technology piece
that gives them feedback and, like, visibility
into where we are with the bundle without
adding more work. Because I don't want my
clinicians
to be sitting at the bedside thinking, okay.
I'm waiting for the exact right moment when
it's when I'm allowed to document the sepsis
reevaluation note. That's not what I want them
to be doing. I want them to be
focusing on patient care. And so by using
the technology kind of arm of this analogy,
we're able to think about how to set
them up to get the right information. Again,
the right information at the right time to
the right clinician.
And so even though our step one compliance
hasn't risen as fast as our mortality rates
have fallen, we have been able to avoid
any value based purchasing penalties this year, which
is a really big deal, and I know
that everyone really cares about that.
But we still wanna, you know, keep getting
better. And so our goal for for next
year is to hit 80% compliance, which is
a tall order. But,
the good thing is that we have DART
to kind of help test and refine changes,
kind of like a sandbox to help us
test test things out and see what works
to help us meet that goal.
So technology in this, because you mentioned Dart,
again, that's really the critical enabler in being
able to at least make a step in
the right direction.
Yes. Absolutely. And Dart has, is really a
configurable
tool. You know, when we first designed
Dart in our setting, we thought, like, oh,
clinicians will engage with it this way, and
this is how we design it. And, you
know, for anything, once you put it into
place, it's not gonna work exactly how you
anticipated. And so being able to sort of
revisit different ways that our clinicians interact with
that tool,
based on real world, you know, examples, we're
able to say, okay. Our clinicians aren't gonna
go here to receive this information, but they
are gonna go to this place. Or they
don't wanna be notified in this way, but
they do wanna be notified in this way.
And so, again, being able to kind of
push and pull levers with the dart tool
to be able to meet clinicians where they
are,
has been really key,
in driving success.
Yeah.
Mary Grace, thank you again so much for
all of these insights. This is such an
incredible conversation. I I wanna turn the floor
over to you. Anything else that you'd like
to share? Any final thoughts on this topic?
Anything else that we we haven't touched on
that's really important for folks to understand?
Yeah. I think the the perspective that we've
taken, which I think has been really effective,
is to really focus on our frontline staff
from the quality perspective.
You know, I think we're all here for
the patients. That's why we, you know, decided
to go into health care in the first
place. But if we sort of back that
upstream a little bit and focus on supporting
our clinicians at the bedside who are caring
for our patients and giving them the tools
and the workflows that they need, they're able
to be set up for success and really
deliver the best care to their patients.
And, you know, it the DART tool really
gives us confidence that we're able to, again,
kinda push and pull up on those levers
to make sure that we find the right
combination of things,
and keep learning learning and adapting to our
systems, which are changing every day. So Yes.
Keep up with all that is hard, but,
we're we're making it through.
It's building the three legged stool together. Right?
Yeah.
That's really, really key. Mary Grace, thanks you
again for being here today. Thank you for
your great insights. Fantastic to have you. Yeah.
Thank you so much, Lucas. And we also
want to thank our podcast sponsor, Zebra Technologies
and Ambien Clinical Analytics.
You could tune into more podcasts from Becker's
Healthcare by visiting our podcast page at beckershospitalreview.com.