Patient flow makes hospitals safer

This post was inspired by this video published by the Rory Staunton Foundation and posted by The Leapfrog Group on Twitter.  Sepsis a common cause of death in hospitals, killing more than 200,000 Americans each year.  Half of these patients could be saved by "early recognition and rapid treatment", via sepsis bundles.  But these bundles or protocols are just the beginning.  We'd like to add value to this conversation by introducing the concept of patient flow.  At Amplefi we see patient safety as a function of patient flow.  A hospital cannot be truly safe if patient movement or the supporting processes are riddled with delay.

Prevention is better than Fixing

A sepsis bundle is a protocol that care providers follow when a patient is suspected to be at higher risk of developing sepsis.  All steps in the bundle must be followed or the patient will be put at risk.  The basic idea is to detect and kill the infection quickly before it gets a chance to strengthen and overwhelm the body.

The bundle itself is in effect a predictive model. It uses 'medical intel' (vital signs) to watch for things that deviate from the 'reference model' (fever, elevated heart rate) in order to prevent the infection from getting too strong.  After all, infections are easy treat if they are caught early enough. 

With the implementation of electronic health records, it should be easier to spot potential sepsis victims.  Tragically it is not.  Special tools are required to tap in the the specific data needed to power the bundle.  These data tools (like Vantage CP) can pull out relevant health data from patient's records, flag the patients that are most at risk for developing sepsis, and send alerts out to the relevant charge nurses.  

Its easy to wrap up the safety project here, but there is a more serious issue at play.  Screening patients for sepsis is only part of the solution.  According to the Society of Critical Care Medicine's article "Sepsis: The Value of Screening Tools":

Some institutions have opted to appoint nurses whose only responsibility is screening and follow-up on sepsis treatment. Use of these nurse champions has improved screening compliance but has not always translated into increased treatment of sepsis.(14) Identification of patients alone does not ensure that early treatment will occur.

So, assuming the staff has properly screened and identified at risk patients.  Now what?  How are the patients going to get the treatment they need? How will you treat patients that have developed severe sepsis or septic shock? How will you treat patients that present in the ED with severe sepsis?  The clock is ticking.

If providers miss the window of opportunity to prevent sepsis, they will need to move the patient into intensive care/surgical areas.  This is the most important step; these patients need to be moved into the proper beds as soon as possible, or outcomes could be fatal.  

It would be really tragic for your ICU to be full when someone with probable sepsis is lying on a gurney in the emergency department.

Patient Safety is a function of Patient Flow

American hospitals are being blamed for sepsis fatalities because their operational performance is such that they are either missing the signals, or are too slow to act. Its easy to see why a multi-tasking nurse in an ED might miss warning signs or not be able to do anything about them, effectively letting a patient sit and wait for an ICU bed for hours upon hours.

If someone meeting the criteria for monitoring in the ICU then they need to go to the ICU, not sit in the ED.  It is essential to the safety of patients that critical care areas always have space available.

Unfortunately most hospitals today don't have space available.  Their ICU's are full of patients that do not require intensive care, patients who need to be stepped down in care.  

Those ICU patients can't be stepped down because patients who are ready to go home haven't been discharged yet.  They are still taking up bed space and sucking up nursing resources.  Why is this happening? Because the hospital as a whole doesn't have its act together on the patient discharge process.  There is no patient flow!  

You cannot run a safe hospital if a septic patient has to wait in an ED for a bed while life saving treatments are being delayed because you haven't figured out a way to get some shlub in room 3056 out the door before dinnertime.