HCA uses predictive analytics to spot sepsis early

Like many health systems, HCA Healthcare has been working for years to reduce patient mortality from sepsis by adopting the bundles created by the Surviving Sepsis Campaign. And although sepsis mortality declined at the hospital giant by 39% from 2013 to 2018, clinical staff knew they were still missing cases because the condition is notoriously hard to detect, especially early on.

“Sepsis is like a raging fire,” said Dr. Jonathan Perlin, HCA’s chief medical officer. “When you realize there’s a fire, it’s out of control.”

Sepsis is a life-threatening complication that kills about 250,000 people per year in the U.S. and cost Medicare more than $6 billion in 2015, according to a Modern Healthcare analysis of Medicare claims data.

Motivated to see what else could be done to identity sepsis at HCA’s 185 hospitals, some clinical and information technology staff in 2017 came up with SPOT, an alert system embedded in the electronic health record that evaluates patient data in real time.

To develop SPOT, which stands for Sepsis Prediction and Optimization of Therapy, clinical staff scoured 10 years of HCA patient encounter data for known cases of sepsis and then identified common characteristics associated with the condition. Those characteristics were then embedded into SPOT as the criteria used to detect sepsis in every patient.

“We wanted to build a smoke detector to sniff out the earliest signs of sepsis,” Perlin said. 

Performance data so far shows that from 2017 to 2018, SPOT has helped reduce sepsis mortality by an additional 23% at HCA, Perlin said.

SPOT works by evaluating every new piece of information that is added into the patient’s health record during an inpatient stay including their vital signs, lab results and nursing reports. This is something staff can’t do.

“You want your clinician to be not only at the bedside but also at the computer looking at every new piece of data, every new blood culture and you want them to act on it the moment it was created,” Perlin said. “But clinicians can’t be both at the bedside and at the computer.”

SPOT generates an alert in the EHR if a patient meets the criteria for sepsis. Who gets the alert depends on the hospital. At small HCA hospitals, physicians and bedside nurses will receive the alert. At TriStar Centennial Medical Center, a 744-bed facility, a rapid-response team staffed with experienced intensive-care unit nurses gets the alert. The hospital’s reported rate of 4.15 cases of post-operative sepsis per 1,000 elective surgical discharges in 2017, according to Modern Healthcare Metrics, put it below the benchmark 5.37 rate for hospitals with 500-plus beds.

One person is at a computer 24/7 to respond. When an alert comes in, the nurse checks the data to confirm sepsis treatment is needed.

If the nurse agrees sepsis treatment is required, he or she quickly lets the patient-care team know. That includes the on-call physician. TriStar Centennial has a secure messaging system that allows staff to easily text or call one another.

Dr. Michael Nottidge, an ICU physician and critical care medical director at TriStar Centennial, said the setup works well because the rapid-response team rounds daily and they are familiar faces to most of the clinical staff. 

In cases where the alert shows the patient is showing early warning signs of sepsis, the nurse will initiate the first steps of the Surviving Sepsis Campaign bundle, including obtaining blood cultures and ordering antibiotics. With alerts that show more serious signs of sepsis, the nurse will usually send another member out to attend to the patient immediately while alerting other clinical staff.

There have been times when the alert system misidentified sepsis, Nottidge said. For example, SPOT once flagged a patient as septic but later on the condition was diagnosed as hemorrhagic shock. Even in those cases Nottidge said patients still benefit because they are more closely monitored.

SPOT is now used in the inpatient units at all 164 HCA hospitals with the Meditech EHR and HCA is rolling it out to its remaining facilities. Perlin said HCA hasn’t yet evaluated the cost savings associated with SPOT.