Sutter Health

Hospitals Help Reduce Deaths from Sepsis Using Microsoft Technology

Sutter Health, a community-based, not-for-profit association of 26 hospitals and 5,000 physicians decided to screen to identify intensive care unit (ICU) patients who might be susceptible to developing deadly sepsis, an inflammatory reaction to infections. As an alternative to paper forms, Sutter’s internal developers created an electronic forms–based solution using Microsoft® Office InfoPath® 2003, Microsoft Office SharePoint® Portal Server 2003, and Microsoft SQL Server™ 2005 Enterprise Edition. The solution has helped hospitals to save lives for ICU patients who develop severe sepsis. Development of the solution took only 60 days and has proven popular with physicians and nurses because it is easy to use and provides life-saving data. The company also enjoyed a U.S.$900,000 savings from cost-of-care reductions, and $48,000 in labor savings within the first seven months.

Situation

Using the InfoPath solution, we are saving lives because of our early detection and treatment of sepsis. Dr. Daniel Ikeda Medical Director Sutter Sacramento Sutter Health

Sutter Health is an association of not-for-profit hospitals and physician organizations that share resources and expertise to advance healthcare quality. With 43,000 employees plus 5,000 physicians, and 26 hospitals, Sutter Health serves more than 100 communities in Northern California. Its not-for-profit hospitals are regional leaders in pediatric, obstetrical, heart, and cancer care.

Many of Sutter’s hospitals have intensive care units (ICUs). Sutter also has two electronic ICUs (eICUs), which are offsite facilities staffed by specialized physicians called intensivists, who specialize in caring for patients requiring ICU services. The eICU brings intensivist-assisted care to smaller hospitals that would otherwise not be able to provide the higher quality care of an intensivist. An intensivist remotely monitors a patient’s vital signs, lab and radiology results, and visually monitors the patient through a video link. This monitoring occurs 24 hours a day and provides for immediate intervention as needed.

As part of its commitment to enhancing patient care, Sutter has joined the Surviving Sepsis Campaign to reduce the mortality of sepsis. Sepsis occurs when the body has massive inflammation in reaction to an infection, and is most commonly found in severely ill patients who are exposed to bacteria either before or after entering the hospital. Severe sepsis strikes some 750,000 patients a year in North America, with a 30 to 35 percent mortality rate, according to the Surviving Sepsis Campaign, an international cooperation of healthcare providers and organizations.

The Institute for Healthcare Improvement (IHI) a not-for-profit organization based in Cambridge, Massachusetts, is dedicated to accelerating change in healthcare by cultivating promising concepts for improving patient care and turning those ideas into action. The IHI developed guidelines and best practices for ICU and other hospital staff to use in detecting and treating sepsis early to reduce mortality and enhance outcomes.

The IHI screening and treatment tool has proven effective in reducing deaths from severe sepsis, but because it is typically implemented with paper-based forms, the guidelines can be awkward to work with in a clinical setting, and there is a lag between data capture and analysis because handwritten documents have to be rekeyed into a computer.

Sutter Health determined that reducing the mortality of sepsis was so important that the tool needed to be incorporated into the clinical workflow so that every ICU patient could be screened for sepsis, and given early treatment if sepsis developed.

“Sepsis kills more people in a year than heart disease or lung cancer,” says Teresa Rincon, Nurse Director of the eICU at Sutter Health. “The inflammatory response can overtake the body. The heart rate goes very high and blood pressure can get dangerously high. Patients can go into multi-organ failure, so it’s very important that we have a rapid assessment, recognition, and treatment of sepsis.”

Dr. John Mesic, Chief Medical Officer for the Sacramento-Sierra Region of Sutter Health, notes: “At Sutter Health we pulled together a group of individuals including physicians, nurses, and people from our Information Technology group and asked the questions: ‘How can we better detect those patients who are at risk for sepsis? And how do we then ensure that all of these patients are getting the appropriate treatment?’ We saw that computers could play a key role, but we needed to find the right solution.”

Solution

The Sutter Health Web Center and Enterprise Data Services teams worked with physicians, nurses, and other stakeholders to design a solution based upon

Rapid-cycle development worked amazingly well with InfoPath and SharePoint [Portal Server]. In fact this is a project we couldn’t have done without using InfoPath forms and the SharePoint site. Grace Bourke Senior Technical Project Manager Sutter Health

the IHI screening and best practices documents. The solution uses the Microsoft® Office InfoPath® 2003 information-gathering program to create electronic versions of the documents which are filled out by Sutter nurses and physicians. The InfoPath forms are used to collect information that is stored in a Microsoft Office SharePoint® Portal Server 2003 document library. Data is also loaded onto a Microsoft SQL Server™ 2005 Enterprise Edition database for analysis and reporting. Results are shared with the Surviving Sepsis Campaign to enhance the overall knowledge base for sepsis treatment.

The solution was deployed using the Microsoft Windows Server® 2003 Enterprise Edition operating system on servers and the Windows® XP Professional operating system on work stations. Development was done using Microsoft Visual Studio® 2005 and the Microsoft .NET Framework version 2.0.

Every patient coming into the eICU is screened for sepsis using the Office InfoPath version of the tool. “When a new patient enters the ICU, the nurse answers a series of questions on the sepsis screening tool,” says Joyce Mancini, a Registered Nurse at Sutter Health. “InfoPath generates an alert if the values indicate potential for sepsis. An eICU physician will review the patient’s chart further, looking at certain lab values, looking at key vital signs, and determining if the patient needs to be treated for sepsis.”

Out of the first 6,500 patients screened, about 100 were found to have sepsis. The solution based on Office InfoPath and Windows SharePoint Services was used to provide evidence-based guidance for treatment and to monitor patients to ensure they received the best care possible.
“From the eICU, we are able to intervene with patients in remote rural facilities that don’t have specialists available to them,” says Rincon. “We can monitor in real time laboratory data and vital signs such as blood pressure and heart rate. We’re able to enter the room with a camera and other high-tech audio/video equipment in order to talk to nurses, patients, family members, and physicians at the bedside with the patient. That is how we use technology to improve the care of patients in the Sutter system.”

Benefits

Sutter Health has enjoyed a range of benefits since deploying its solution using Office InfoPath and Office SharePoint Portal Server, including helping to save lives, ease of development, ease of use, and an anticipated U.S.$1.8 million annual reduction in cost of care and labor.

Helps to Save Lives

The most important benefit Sutter Health has enjoyed from deploying its Office InfoPath and Office SharePoint Portal Server solution has been to help save 125 lives, so far, from severe sepsis in ICU and eICU patients, because of early detection and treatment. “Using the InfoPath solution, we are saving lives because of our early detection and treatment of sepsis,” says Dr. Daniel Ikeda, Medical Director for the Sutter Sacramento eICU. “We have reduced sepsis mortality from about 40 percent to less than 15 percent.”

“We have been able to save over 50 patients in the last three to four months,” says Dr. John Mesic, Chief Medical Officer for the Sacramento-Sierra Region of Sutter Health. “On a historic basis, much of the healthcare provided hasn’t been evidence-based, and probably the single most important reason was our inability to track the data because the data was collected by hand and had to be manipulated by hand. In today’s environment, technology has enabled us to collect more data, and evaluate that data in multiple dimensions so as to better identify the cause and effect of any treatment that we may initiate. Information technology essentially enables us to collect more data and become better healthcare providers through learning from that data.”

The reduction in mortality being achieved with InfoPath and SharePoint Portal Server represents a significant milestone. “There is great hope that this new paradigm of using technology to alert us, and having a standardized mechanism for treating the disease state, will result in many lives saved,” says Dr. Ikeda. “I am an infection disease specialist and I deal with antibiotics all the time. I have never had an antibiotic that gave a 50 percent reduction in mortality. That’s how big this is.”

The ability to save lives was a big motivator for the development team. “This project is rewarding because we know we make a difference,” says Grace Bourke, Senior Technical Project Manager at Sutter Health. “A patient with sepsis isn’t just a number in a database. That patient is somebody’s mom, somebody’s father, somebody’s brother, somebody’s aunt or uncle, so we want to make a difference with those patients.”

Those words ring especially true for Matt Empringham, a Web Center developer at Sutter Health. “My mother was hospitalized with sepsis just as we were completing this project,” Empringham says. “I went to visit with my mom in the hospital and her body was shutting down. I asked her questions that were in our InfoPath form to determine how she was doing. I was able to interact with the doctor because of this knowledge. Fortunately she recovered, but it underscored how important this work is.”

Ease of Development

When Sutter Health created its team to implement its sepsis screening program, all participants were focused on how to deploy the best solution as quickly as possible to improve patient outcomes.

“We used the products that were best suited for the project, which turned out to be InfoPath and SharePoint [Portal Server],” says Bourke. “We did something that is very new to healthcare, but that we’ve seen applied in other industries very successfully, which was using a rapid-cycle development. Our philosophy was that we couldn’t simply go off and build something for a year. We had to build our solution in 60 days and then fine tune it, working with the nurses and physicians who would be using it. Rapid-cycle development worked amazingly well with InfoPath and SharePoint [Portal Server]. In fact this is a project we couldn’t have done without using InfoPath forms and the SharePoint site.”

Dan Stein, Senior Technical Project Manager at Sutter Health agrees. “The development time was very short,” says Stein. “It only took about a day to create the form in InfoPath and about a month to develop the Web part. Total time for design and implementation was only about two months and a lot of that time we spent working with the clinicians, identifying the process and planning how the new system would be used. The InfoPath and SharePoint technology was easy to implement and the development cost was very small.”

Derek Peterson, a Web Center developer at Sutter Health, appreciated how easy it was to integrate SQL Server with the InfoPath and SharePoint solution. “We were able to use an iterative building process so we are always able to improve what we have as doctors and nurses make new suggestions, yet we were able to get this out to help the patients almost immediately.”

Ease of Use

During development, the team saw that ease of use would be essential to the solution’s success. They needed to create an application that would not just be easy to use, but that would actually enhance workflow for doctors and nurses.

“We freed clinicians from the chore of writing notes onto a sheet of paper, so they could spend more time at the bedside with patients,” says Bourke. “We barely started our sepsis project and we were already getting requests for more projects using InfoPath and SharePoint [technology]. As soon as people realized the ease of use and the potential of collecting data electronically as discrete data elements and the value of reporting against that data, they saw new ways in which this technology could be used to help them improve patient care.”

Kristen Wilson-Jones, Director of Data and Web Services at Sutter Health, speaks of freeing clinicians from having to search for the data they need. “We don’t want our clinicians to be hunter-gatherers of data,” she says. “With InfoPath and SharePoint [Portal] Server, we make the capture and use of data part of the natural flow of working with the patient. We empower clinicians with data so that they can move from a data hunter-gatherer mode to using the data to improve quality of care.”

U.S.$1.8 Million Projected Annual Savings

A nice side-effect of capturing information on InfoPath forms has been reduction in cost of care and productivity gains for clinicians, and a reduction in costs for re-keying information from paper forms into the computer as was previously done. Sutter Health estimates it saved $900,000 in reduced cost of care and $48,000 in reduced labor within just the first seven months of implementation. Adjusting for the initial ramping up period, Sutter projects annual savings of $1.8 million.

“We are seeing productivity savings for our clinical staff as they are freed from having to hunt for information, and we’re enjoying savings from not having to re-key information,” says Wilson-Jones. “Our clinicians can see upfront and online how their patients are doing.”

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