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Quality improvement lessons: It’s not always about the negative

December 18, 2019

Fourth-year medical students give presentation on their quality improvement study regarding sepsis

From left to right, Alexander Hermesch, Gautham Prakash, Chelsea Wuthnow, Kyle Crooker and Starla Segovia, all fourth-year medical students, give their capstone presentation at KU School of Medicine-Wichita, sharing their quality improvement study findings as part of the Population Health in Practice class.

By Amy Geiszler-Jones

As Chelsea Wuthnow and four other fourth-year medical students at the University of Kansas School of Medicine-Wichita pored over six months of patient records provided by Wesley Medical Center as part of a quality improvement project, they were looking for ways to suggest how the Wichita hospital could better its treatment and mortality rate of patients presenting with severe sepsis.

Instead, their report ended up finding what KUSM-Wichita faculty member Robert Badgett, M.D., called "a pocket of excellence" and showed lessons can be learned from successes as well.

As part of Badgett's Population Health in Practice class, fourth-year medical students undertake a month-long quality improvement study with a health care provider. Teams of students usually spend two weeks looking at a specific process within the provider's system and then two weeks developing suggestions for improvement. The teams make presentations following the conclusion of the studies.

Generally, the lesson learned is that it can be difficult to create change in large, complex institutions, Badgett said.

But Wuthnow's team "found another angle," he said.

"It was an interesting month because we thought we'd find something negative that would need improvement but instead we found that a hospital in our city is doing really well," said Wuthnow.

"In general, in health care, we don't commend ourselves when things are going well," Badgett said, so the project was a refreshing reminder.

For Wesley's Sandy Schremmer, RN, MBA, vice president of quality and infection prevention, the findings confirmed that the hospital system's targeted initiative of identifying and treating sepsis more quickly is working.

For the past three years, Schremmer said, Wesley and its parent organization HCA have been focused on lowering its sepsis mortality rate by getting patients diagnosed and treated with antibiotics within an hour in the emergency room.

Sepsis - a complication that develops when infection-fighting chemicals released by the body's immune system cause inflammation instead - is the leading cause of death in hospitals. One in three patients who die in a hospital has sepsis, according to the Centers for Disease Control and Prevention. Annually, at least 1.7 million adults in America develop the infection and nearly 270,000 die as a result, according to the CDC.

According to medicare.gov, identifying sepsis early and starting treatment quickly increases a patient's chances of survival. The students studying Wesley's sepsis treatment and mortality rate used that same guideline.Kyle Crooker and Starla Segovia present their capstone project

Wuthnow and fellow students Kyle Crooker, Alexander Hermesch, Gautham Prakash and Starla Segovia reviewed Wesley patient records from January through July 2019, trying to see if there was room for improvement for emergency department staff to identify patients with sepsis and start treatment. Patients and providers were identified by assigned numbers to remain confidential.

"We found that they have faster times than what we saw in a lot of other studies," Wuthnow said. "As we dug into the data, we found the majority of their providers are doing really well and getting it under their one-hour goal."

"That was very reassuring for our team to hear that we are doing what we have set out to do," Schremmer said.

According to data on the Medicare website, Wesley's rate of 70% of patients who receive appropriate care for severe sepsis and septic shock exceeds the Kansas rate (60%) and the national rate (57%). Two time frames are considered appropriate treatment time - within an hour and within three hours.

At Wesley and HCA, Schremmer said, the goal is to treat within an hour.

"We feel that one hour is the gold standard for our patients," she said. Sepsis mortality rates at Wesley have fallen as a result.

Schremmer, who has worked with KUSM-Wichita students in the past while quality director at Ascension Via Christi, said she always welcomes opportunities to work with the medical school and its students on research projects.

"They bring a fresh perspective," she said. "They bring an outsider point of view and give us a look at ourselves that we often can't do ourselves."

It's also valuable for the students, she said, to understand the importance of providing leadership as physicians.

"As a nurse, I've been at the bedside and have observed a lot of care being provided. The physician is the leader of the team and what they prioritize for the team can set the patient up for successful outcomes."

Above, right: Kyle Crooker and Starla Segovia speak during their team's capstone presentation at KU School of Medicine-Wichita, as part of the Population Health in Practice class.

KU School of Medicine-Wichita
Last modified: Dec 18, 2019
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Belinda Venters
316-293-3536
bventers@kumc.edu

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