Sallie Arnett experienced the devastating effects of sepsis up close. Her father received a late diagnosis of the life-threatening condition, which resulted in his death. In response, Arnett, the vice president of information systems at Licking Memorial Hospital (LMH), set in motion a strategy to reduce the sepsis mortality rate at LMH to help other families avoid a similar situation.
Sepsis is a potentially life-threatening complication of an infection that occurs when chemicals released into the blood stream to fight off infection cause inflammation throughout the body. This can lead to clots and other blood vessel issues. The condition tends to progress rapidly, which often leads to organ damage and, in many cases, death. According to the National Institute of General Medical Health, “severe sepsis strikes more than a million Americans every year and 15–30 percent of those people die. The number of sepsis cases per year has been on the rise in the United States.”
“I’ve approached this from both a personal and a professional perspective,” Arnett says. “By teaming up with our clinical leadership, I was able to learn about staff challenges with identifying and treating sepsis and was able to seize the opportunity to apply technology to help address their needs.” With nearly thirty years of experience in the healthcare industry, her goal has been to leverage information technology to improve the quality of patient care.
In 1997, Arnett was one of five students to have graduated from the master’s of science in health information systems at the University of Pittsburgh. At that time, the world of technology was still grappling with the cordless phone and the widespread use of pagers, and the internet was still in its nascent stages. “People thought we were a little bit crazy in staking our careers on the concept of information technology in healthcare,” Arnett says.
Following extensive provider and staff education on how to recognize and treat sepsis, LMH turned to technology to help reduce their sepsis mortality rates. Two years ago, under Arnett’s leadership and working in close collaboration with nursing leadership, LMH installed EarlySense Continuous Monitoring technology throughout the hospital.
Each room outfitted with EarlySense includes a small, tablet-sized device to monitor heart rate, respiratory rate, and movement of their inpatients. The device is contact free and is placed under a patient’s mattress or chair pad. Using data obtained from monitoring trends over time in heart rate and respiratory rates, the system provides early warning of patient deterioration.
“Clinical studies have provided evidence that heart and respiration rates are two of the most important predictors of adverse patient events,” Arnett explains.
Prior to installing EarlySense, LMH physicians and staff were already collecting and storing essential patient data necessary for sepsis identification at various locations within the hospital’s EHR system. The challenge was finding the necessary data needed for clinical decision-making at the onset of this dangerous condition.
Using data from multiple locations within the EHR, Arnett’s team set up Iatric Systems Visual SmartBoard, which automatically presents doctors with a complete view of each patient and their sepsis status on a single screen. When the Visual SmartBoard identifies a patient with severe sepsis or septic shock, it immediately takes action to electronically alert the physician as well as the nurse caring for the patient.
This was then integrated with the hospital’s secure texting platform to alert physicians on their smartphones in real time when a patient’s condition is consistent with the Centers for Medicare and Medicaid Services criteria for severe sepsis or septic shock. This automatic detection and monitoring of sepsis allows LMH staff to be proactive rather than reactive.
The team also is responsive to feedback and has streamlined the process since it was first implemented. “Alert fatigue is a serious challenge within our industry, and our team worked closely with our physicians to ensure that they are only receiving the minimum amount of alerts necessary to care for our patients,” Arnett says. “The physicians know that when they receive an alert that it is definitely time to react.”
With support from the Ohio Hospital Association’s Sepsis Collaborative, along with her team, Arnett has reduced the number of sepsis-related deaths from about 27 percent to 9 percent at LMH.
Collaboration and teamwork are really important to Arnett’s leadership strategy and her beliefs often translate to future hospital projects. For example, two current projects concern improving physician and staff communication: one is to evaluate options for a unified EHR for the entire organization to streamline communication across the entire continuum of care, and the second is to replace LMH’s current nurse call system. “There has to be really strong synergy between the clinical and IT staff. They work best with a shared vision and shared goals,” she says.
She admits there is no single solution to every problem presented by working in a dynamic and complex crossover environment such as healthcare IT. “The process has to be collaborative. You need to put the right people into the decision-making process to determine solutions that include all perspectives,” she says.
In a few months, Arnett will be celebrating her eighteenth work anniversary with LMH as vice president—an outlier in her field given that the average tenure for a chief information officer is about five years, she says. She confesses that, “building those relationships takes time, as does understanding the perspective of others. One of the keys to success with any project is getting to know your people when you are building your team.”