Sepsis Improvement
in the NICU

PROBLEM

A pediatric research hospital saw an opportunity to improve sepsis in its NICU based on discoveries during a multi-year, system-wide initiative. A multidisciplinary team composed of clinical stakeholders, quality improvement, informatics, and executive leadership identified gaps in ordering that could be supported by new clinical decision support (CDS).

APPROACH

In order to move the needle on a sepsis initiative, the hospital developed and leveraged clinical pathways. The team believed that a pathway would increase utilization, reduce alert fatigue, and increase clinical effectiveness.

Because the hospital wanted to improve an established order set, the team used Phrase to view its utilization. Phrase provided details on which clinicians placed orders, what orders they placed, and if they were leaving the order set because they weren’t finding the orders they were looking for. This helped the team understand why clinicians were not using the order set and the ways they could modify it.

Based on Phrase data, they optimized the order set to reduce clicks and better align to clinical guidelines. Additionally, Phrase allowed the team to monitor alerts that were established as part of their sepsis CDS bundle. Having CDS data and easy to access previews allowed the team to engage clinicians during the design process to iterate and tailor the design to the workflow. This engagement from the clinical team early in the process helped support a smooth transition of ownership as the project progressed.

RESULT

The team achieved its goal of implementing a CDS bundle that would lead to consistent care across providers. Beyond the successful improvement of alert and order set metrics, the team ultimately was able to deliver an improvement to the average rate of timely antibiotic administration from 58% to 65% in a six month period.