Why Improve Sepsis Protocols and Detection Methods
Written in collaboration by Sepsis Alliance and Cynosure
The question of why might be something you hear throughout your organization. Maybe what follows is that sepsis protocols are “good enough” or that there isn’t bandwidth to improve.
The truth of the matter is, sepsis continues to be a public health crisis that needs our attention. In fact, more than 1.7 million people in the U.S. are diagnosed with sepsis each year. In the United States, sepsis takes a life every two minutes - this is more than opioid overdoses, breast cancer, and prostate cancer combined.
If those facts aren’t enough, sepsis is the number one cause of hospital readmissions, costing more than $3.5 billion each year.
As Sepsis Awareness Month begins, we ask that you to take another look at your sepsis protocols and detection methods. We encourage you to see if there are any obvious areas for improvement. Improving our sepsis protocols and detection methods can (and will) save lives.
More about Sepsis Alliance
Sepsis Alliance is the leading sepsis organization in the U.S., working in all 50 states to save lives and reduce suffering from sepsis. The organization was founded in 2007 by Dr. Carl Flatley, whose daughter Erin died unnecessarily of sepsis when she was 23 years old. Sepsis awareness can and does save lives, yet only 63% of American adults have ever heard the word sepsis.
The Sepsis Alliance team works to produce information for both healthcare professionals and the public to elevate sepsis care with education, resources, and networking.
We encourage you to register for an upcoming educational event - the Sepsis Alliance Summit! Join Sepsis Alliance for a FREE, virtual conference on sepsis held on September 27 and 28, 2023. Sepsis Alliance Summit features two days of virtual expert-led sepsis content and opportunities to engage with other healthcare professionals. Free continuing nursing education credits will also be available!
Where to Start to Improve your Sepsis Protocols and Detection Methods
Sepsis Awareness Month is a great time to begin to examine your current efforts and gain ideas and inspiration for further improvements. As you begin to take further action to improve awareness of sepsis mortality and morbidity, a great first step is to assess your current practices using the Cynosure Sepsis Discovery Tool to provide a real time evaluation of your current processes and by reviewing the 2023 Cynosure Sepsis Safe Hospital Self-Assessment.
Next, connect with the right information and tools to support your efforts. Sepsis Alliance has released a Sepsis Awareness Month tool kit to help inspire your Sepsis Awareness month activities.
Then, join us as we highlight hospital best practices in our Cynosure Sepsis “How to” Series:
- Sepsis Screening & Implementing an Hour One Bundle will be featured on September 21 @ 1:00 pm EST register here
- Handoff checklists and Post Sepsis Support Groups will be featured on September 28 @ 1:00 pm EST register here
Now is the time to get started! You can learn more about sepsis and find other ways to get involved at sepsis.org.
Emerging Problems in the US Health Care System: 3 Ways to Mitigate Diagnostic Errors in Medicine
Diagnostic harm and diagnostic improvement have become buzzwords in patient safety and risk management and with good reason. A recent study by Johns Hopkins showed that medical providers misdiagnose 11% of the time, but this rate differs widely from 1.5% diagnostic error rate for heart attacks to 62% diagnostic error rate for spinal abscesses. This is cause for considerable problems in the US health care system, especially when it’s already feeling fragile post-pandemic.
The good news is that we in the medical community recognize a problem, and we’re ready to do something about it. So, how do we mitigate diagnostic harm and help reduce diagnostic errors in medicine?
1. Develop Tactics to Identify and Learn from Diagnostic Errors or Near Misses
We have so much data at our fingertips, and we can use this to learn from or identify any diagnostic errors. Here are a few places you can find a diagnostic error or a near miss:
- Use data: Review adverse event reports or any medical malpractice data. Gaining knowledge and learning from the data at hand helps ensure history isn’t repeated.
- Learn from your patients: Review patient complaint logs. They can tell you so much about the patient’s feelings, where a diagnostic error might have happened, and what steps could help in the future.
Now we know where to find them, but what do we do with it? We suggest a regular cadence of review of these data points. Gather a team that will review together and then strategize different ways to mitigate this instance in the future.
2. More Effective Teamwork during Diagnostic Process
A lot of times, more eyes, more ears, more brains, and more experiences coming together can create a better overall diagnosis for a patient. We suggest having a process where multiple health care professionals are involved with a diagnosis, especially a more difficult case or one you’ve rarely seen. No matter how many years of experience you have, there can always be something missed or symptoms you haven’t been presented with before that can cause a misdiagnosis.
A great place to start is working with your Quality Director to create a small test of change in how to gather a diagnostic team.
3. Enhancing Health Care Professional Education and Training Around Diagnostic Process
More training and education is usually a great answer when there’s a problem to tackle. When it comes to something like diagnostic accuracy, a refresher course is a great place to start. Thankfully, ARHQ’s TeamSTEPPS Diagnostic Improvement Course is developed to improve diagnostic accuracy for individuals or large groups. For more information on the course, please go here.
At Cynosure, we have many team members that are certified TeamSTEPPS trainers and know the ins and outs of the TeamSTEPPS Diagnostic Improvement Course. If your organization is wanting to implement this vital training, but isn’t sure how to get started, please reach out to us today.
Care Transitions: Improving Discharge Phone Call Outcomes
When it comes to discharge phone calls, we often encounter the "my patient didn't answer" obstacle. Such a vital piece of the care puzzle should get bypassed because our team was sent to voicemail. This article outlines a few ways to increase the chances of patients answering this important phone call.
Tactics to Increase Answering of Discharge Phone Call
1) Tell the patient in advance that you will call and share the purpose of the call or details you might discuss
2) Schedule a convenient time for the call
2) Ask if a significant family member or caregiver can be present and make sure the scheduled call works for them
3) Create reminder magnets with the date and phone number you'll be calling from
4) Put a post it note with the date and phone number on the top of the discharge papers
Bonus: Telling the patient and/or caregiver the phone number you'll be calling from ensures they have a callback number in case they miss your call or they need help prior to the follow up
Example: What can I do to Improve Care Transitions in 1 Week?
Let's walk through an example involving explaining the discharge phone call, scheduling a day and time for the call, and what number they will receive the call from.
Monday: Review the QI Project Planning Worksheet that will guide you through the steps of planning for a Small Test Of Change (STOC).
Tuesday: Huddle with your hospital team that will be involved in testing something new and explain the expectations.
Wednesday: Test one change idea with one or several discharges that day. Huddle with your team after. How did it go? What would make it easier? What challenges did you encounter? What will you do differently with the next patient, tomorrow?
Thursday: Try the test again with modifications based upon Wednesday’s experience.
Friday: Call the patient or family caregiver that you tested advance notification intervention with. Did they pick up the call? If yes, what made them answer? If no, reflect on your STOC conducted on Wednesday. Will you adapt or abandon the change idea? Will you try adding a post it note with the date, time and phone number you will be calling from?
All this to say, discharge phone calls may be low-hanging fruit to capitalize on that can do a great deal to help decrease your readmissions and continually better serve your patient population. If you’re looking for more ways to improve your Care Transitions, reach out and we’d be happy to talk strategy with you.
Free Social Drivers/Determinants of Health Online Training
Are you or your team left feeling uncertain about how to screen for social drivers/determinants of health (SDOH)? We understand that it can be tricky to navigate such sensitive topics. And if you aren’t sure where to start, determining what screening tool to use can be overwhelming.
Thankfully, we have some resources that can help.
The Cynosure Learning & Improvement Connection (CLIC) hub has several resources around SDOH, and they are all completely free. These short but thorough courses will answer your pressing questions, bring new light to what might feel like daunting tasks, and give you and your team newfound confidence regarding SDOH screening practices.
Social Drivers/Determinants of Health Online Training Courses Offered by CLIC hub
- Getting Started with Screening for Social Drivers of Health – Students will learn through video modules and document downloads the varying SDOH screening tools available, their pros and cons, and determine which tool makes the most sense for their organization. The course should take less than 10 minutes to complete, including reading through source materials.
- SDOH Training: Creating a Trusting Environment – In this short course, students explore the best ways to navigate tough questions like “Do you have a safe place to sleep tonight?” and “Can you cover your electric bill this month?” These questions can feel so intrusive but are often critical to our patient’s well-being. Knowing the answers often lend us to a better overall medical outcome. It should take no longer than 10 minutes to review this course and its source materials.
Why Get CPHQ Certified? And Other Answered Questions about CPHQ Certification
As health care professionals, enhancing our skills and improving patient safety outcomes is always on our minds. But what if beyond only a patient to patient basis, you could influence global change and improvement at the organizational level? This is what the quality manager or director can do. If you have these dreams, it’s time for a serious look at career advancement opportunities.
So how do you land a position like that? Even with a stacked resume featuring glowing recommendations and advanced skillset, it can be difficult to move positions. A great way to stand out amongst your peers is to prove your commitment to quality improvement through the Certified Professional of Healthcare Quality (CPHQ) accreditation.
This article will outline the benefits of the CPHQ certificate, how to get CPHQ certified, and ways to prepare for the CPHQ exam.
Benefits of CPHQ Certification
You might not be interested in taking on more education. But CPHQ certification can prove to have more positives than negatives in many situations. We’ve outlined a few reasons why getting CPHQ certified can benefit you.
Career Advancement
The CPHQ Certification shows commitment to your profession and the position you hope to hold. This helps set you apart from your competition and let’s others see you are ready for career advancement. In fact, according to National Association of Healthcare Quality (NAHQ) research, CPHQs work at higher levels of competency and hold higher job titles than non-CPHQ peers.
Advanced Knowledge in Health Care Quality
Beyond standing out for additional career opportunities, you will learn and prove advanced competencies in health care quality improvement. If you’re wanting to make an impact on patient safety and outcomes, this is how you can build on your current knowledge and know you’ll make a difference.
Enhance Credibility Amongst Peers and Network
With career advancement opportunities and advanced quality improvement knowledge, you will gain new respect and credibility from your peers and broader network. New opportunities can open up like being asked to sit on committees, attend specialized conferences, and more.
How to Get CPHQ Certified
Now you might be wondering “how do I actually get certified?” There is currently only one universally recognized accredited certification in healthcare quality, and that is the CPHQ certification through NAHQ.
You earn the CPHQ certificate by receiving a passing score (a 600 or better on a 200-800 scored scale) on the CPHQ exam. There are a few ways you can properly prepare for the exam to ensure a passing score and achieve the certificate.
Ways to Prepare for the CPHQ Exam
The best way to prepare for the CPHQ exam is finding an online prep course that sets you up for success. We recommend one with a comprehensive practice test, accessible and educational review courses, source materials, and sample questions or other exam-readiness indicators.
Finding the right way to prepare for the exam can be tricky, and sometimes when you find the option that fits all your needs, you could wind up spending hundreds and hundreds of dollars. And although for all the benefits, that cost might be worth it, we would like to offer a better solution.
The Preparing for CPHQ Exam: A Comprehensive Overview for Quality Professionals course on CLIC hub offers everything we recommend above with online, on-demand modules that you can access anytime you can spare a few moments in your ever-busy schedule.
Learn more about the course, modules, and what to expect to prepare for the CPHQ Exam here.
What social drivers of health (SDOH) questions should you ask?
Social drivers (also known as determinants) of health (SDOH) are the conditions in the environment where people live that affect quality of life, health outcomes, and risks. They include things like poverty, education level, access to health care (or lack thereof), etc. These factors impact our patients’ health before, during, and after any health care encounter. They also contribute to inequities and disparities in both care and outcomes. To truly deliver patient-centered care that accounts for each patients’ unique circumstances, we must consider how social drivers of health influence their lives.
One way to better understand any challenges your patients face – as well as assets in their communities, families, and homes – is to ask questions about these socio and economic factors. With this information, you can better partner with patients, their families, and care team members across your organization to design a care plan that addresses the non-medical factors that can play a huge role in the healing process.
The Centers for Medicare & Medicaid Services (CMS) worked with organizations across the country through the Accountable Health Communities Model to test approaches to asking patients about their health-related social needs (HRSNs). This effort led to the creation of the Accountable Health Communities Health-Related Social Needs Screening Tool, which includes 10 core questions about:
- Housing instability
- Food insecurity
- Transportation problems
- Utility help needs
- Interpersonal safety
Participants in this CMS Model tested different approaches to administering the screening tool and referring patients to available services to address their needs. These sites learned a lot. Hospitals who are now setting up their own processes to screen for and address SDOH can learn about strategies to make the business case for addressing SDOH, align payer and provider activities to address SDOH, expand and scale efforts to address SDOH, and more.
The CMS AHC HRSN screening tool is just one of many screening tools available to use. Whether you use the CMS AHC HRSN or another tool, any information you can gather about the non-medical factors your patients face will help you develop care plans that will more effectively promote healing and health.
Are you ready to take a deeper dive into how to navigating asking tricky SDOH questions? The free course SDOH Screening: Creating a Trusting Environment is exactly what you're looking for. Sign up today to help better address important SDOH questions with your patients.
Social “determinants” or “drivers” of health (SDOH): What are they and how to address them
For those not immersed in health care jargon, the phrases “social determinants of health” or “social drivers of health” may cause you to scratch your head. Even if you work in health care, you might have only vague familiarity with the concept.
Increasingly, however, all of us in the health care field are called on to understand and address social drivers of health (SDOH, for short). That call is louder and more insistent every day. Hospitals, especially, are being challenged by regulators, public health professionals, advocates, and patients to consider their influence on the underlying social and economic conditions that lead to health and wellness, or lack thereof.
So, what are SDOH?
SDOH are the non-health care factors that influence our health and well-being. It turns out, over 70 percent1 of our health is influenced by factors outside the health care system. If we only focus on treating people when they come through our doors with illness or injury, we won’t make progress toward improving health.
The call to action, therefore, is to better understand the underlying factors— like poverty, availability of safe housing and healthy food, education quality, and more—so that we can change the conditions that will lead to greater health and well-being.
The World Health Organization (WHO) identifies the following as SDOH factors to be aware of:
- Income and social protection
- Education
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities, and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality
The Difference between Social Determinants of Health and Social Drivers of Health
For decades, public health researchers described these as “social determinants of health.” Recently, based on input from patients, some (including the team at Cynosure Health) are evolving to use “social drivers of health” to suggest that these conditions are not fixed and determinative, but indeed can be changed and improved.
Learn more about this change to Social Drivers of Health here.
What can we do about SDOH?
Hospitals are experiencing new requirements, pressure, and opportunities to understand and address SDOH, especially for their most vulnerable patients. The Centers for Medicare and Medicaid Services, accreditors like The Joint Commission, along with patients, advocates, and community members are urging hospitals to get serious and strategic about investing in SDOH.
This charge to focus on underlying conditions that promote health is consistent with the mission of many hospitals and health systems. The vast majority of such institutions express a commitment to promoting to health in their communities. Arguably, one cannot promote health without seriously addressing the conditions that influence health.
We now have alignment between decades of public health research on the importance of addressing SDOH, and incentives for hospitals and health systems to meaningfully invest in this work. And yet – the bridge between knowing what to do and how to do it is a difficult one to cross.
At Cynosure Health, we are talking with and learning from hospitals on the frontlines of this work. We’ve hosted brainstorming sessions with hospitals who are building processes to consistently screen patients for SDOH; we’ve built hospital-based social needs indices to translate community-level data to a hospital perspective; and we’ve supported efforts to address disparities in hospital quality metrics in California hospitals. We’ve learned an incredible amount about how we can all move forward together to meaningfully understand and influence SDOH.
- The smartest, most efficient way to do this work is to partner with patients and community members. As hospitals develop a deeper understanding of their patients’ lives beyond the hospital walls, they are challenged to think differently about their role in addressing these needs. Hospitals should look to their most valuable partners and sources of information and insight—their own patients—to inform how they talk with patients about social needs or drivers; institute meaningful referral processes; and invest in programs or partnerships that truly meet community needs. Learn more: Social Drivers of Health (SDOH) Screening Questions
- This work is new, and hospitals large and small are tackling it head-on. Many hospitals are in the early planning phases, especially related to new requirements to screen patients for SDOH. It is no small undertaking to build processes that account for adequately training staff; documenting information across disparate electronic health records; and ensuring the clinicians who have conversations with patients are creating a compassionate, psychologically safe environment.
- Identify and integrate with other resources. Hospitals do not have to do this work alone; in fact, they most definitely should not do it alone. We’ve heard from hospitals who are aligning with and integrating with existing resources, such as health information exchanges, community-based organizations, social service organizations, and regional or state initiatives that are also focusing on SDOH. Before you begin, look around at what already exists and how you can join in and build on the work that’s already begun.
- Not all needs will be met, but data shines a light on challenges. We hear often that hospitals, especially when discussing screening for individual SDOH, are concerned that they will not be able to meet all of the needs they identify. This is inevitable and should not stop hospitals from working towards sustainable individual screening processes, or from gaining a deeper understanding of the systemic barriers that exist in their communities. Instead of being discouraged when we identify unmet needs, we must muster the courage to share this knowledge with others and advocate for the resources, policies, and investments that will lead to community-wide improvements in health. Learn more: Social Drivers of Health (SDOH) Screening Tools
While some hospitals have been pioneering efforts to address SDOH for years, many are still very new at both understanding and addressing these needs. We may not get things right the first, second, or third time around, but if we focus on listening to and partnering with patients, families, and our communities, we can make progress toward more equitable health care and outcomes.
If you’d like to keep the conversation going, we have an active group of over 2,100 members ready to learn and grow together. Join the Social Drivers of Health Community today!
How to select a social drivers of health (SDOH) screening tool
Hospitals are increasingly called to understand and address the social drivers of health (also known as social determinants of health – SDOH for short) for their patients and communities. It is a concept we are learning more about each day. We realize that much of what affects our patients’ health happens well before they step through our doors. Properly being able to identify some of these factors can help us provide better and more efficient care that can solve the root cause of illness and not just the symptoms. Recognizing this, CMS, the Joint Commission, and others are now requiring hospitals to screen for and address SDOH.
One way to better understand the social and economic factors that influence your patients’ health is to use a screening tool to ask individuals about their needs. Knowing where to start and what tool is right for your organization can be tricky, though. That’s why we’ve come up with this handy guide of considerations to help make the selection hopefully a little easier.
What to consider when reviewing different SDOH screening tools
- Does it align with your organization’s needs and goals? Will the tool fit with your strategy and mission? Would it help you achieve your goals related to SDOH screening for SDOH, and will it help you collect the information you need?
- What resources already exist within your organization? Consider the tools that already exist in your organization—for example, some units may already be testing SDOH screening as part of pilot or grant-funded programs. Consider also whether your EHR has built-in screening tools that would meet your needs.
- Does it meet CMS & Joint Commission Requirements? Many regulators, accreditors, and payers are now requiring screening for social drivers of health or health-related social needs. These requirements are similar but not exactly the same, so be sure to cross-check which questions are required, and ensure the tool you select aligns.
If you’re interested in learning more about how to select an SDOH screening tool that works for your patients and your organization, check out our FREE 5-minute mini-course on this topic. Our instructor, Natalie, walks you through different factors to consider when selecting the tool, resources for SDOH, and additional insights from other key players regarding SDOH screening tools.
Sign up for the FREE SDOH screening tool course here!
Health Care Resilience Roundtable Recap: How we keep moving forward and lead through tough times
Our Resilience Roundtable 2023 – Leading in Tough Times: Applying Cross-Sector Lessons on Resilience in Health Care was a gathering of great minds to explore the next phase of health care. We may not have all the answers, but we (you included!) are the ones to create those answers. We are merely discovering what health care resilience means for each individual organization and team. Each of us must hypothesize, test, and rework our approaches to continually improve over time.
While we gather different tactics and identify barriers, we hope that some of these ideas and insights help spark a new way of thinking for you and your team. Let’s do a brief recap of main topic areas that were discussed:
In our first session, “Setting a Strategy that Promotes Resilience,” Charles Vincent, Jan Hagen, and Peter Angood reflected on:
- Necessary versus unnecessary resilience in health care – leaders must be attuned to underlying system and resource changes that should occur, even if team members are exhibiting resilience. We must ask - how can we recognize when resilience is not the solution?
- Need for better data – drawing from experiences in the airline industry, we heard a call for better data on both negative and positive patient safety events, as well as the multiple internal and external factors that influence health care.
- Transparency and collective improvisation – Leaders should engage their teams in planning how they will collectively improvise in the face of both acute and chronic stressors.
In our second session, “Creating a Culture that Enables Resilience,” Amy Edmondson, Tim Vogus, and Sara Singer described:
- Psychological safety – the imperative to create an environment in which team members support each other in anticipating and addressing failures.
- Creating the right culture…and also fixing broken systems and processes – Simplify and standardize where possible to free up time to focus on improvement efforts.
- Who is on “the team”? - Family members are a crucial source of health care resilience and early detection for patient safety. Consider ways to think more broadly about who is “essential” in supporting patient safety.
In our final session of the day, “Operationalizing Systems to Respond to Unexpected Circumstances,” David Gaba, Libby Hoy, and John Chessare explored:
- How to narrow the gap from the front office to the frontline – transparency and improved communication can help all stakeholders understand the true nature of the challenges we face.
- Fantasy documents – although we spend time and resources developing emergency plans and procedures, we often know they won’t actually work. How can we improve our efforts to prepare for stressors?
Want the full scoop from this event? Stay tuned for links to the sessions, coming soon!
For the New Quality Manager in Health Care: Determining Where to Start
Stepping into any new role is scary, but stepping in as a new Quality Manager in health care can be particularly challenging. You may be so familiar with being on the floor or in a clinical setting and dealing with the hustle that brings, that switching to this role may feel completely overwhelming. And that’s okay.
As a quality manager in health care, you’ll take on new acronyms, reports, leadership strategies, improvement planning, and more. Just when you thought you’d made the right career decision, you probably started to second-guess it. Yearning for the familiar is normal and expected, so we assure you that you aren’t alone in this.
Now we aren’t saying this to imply there’s nothing you can do about it. In fact, we have a handy guide to help you navigate those first few months to help ease the transition.
Find Other Leaders in the Organization
Getting to know your new colleagues and their roles in the organization is a huge first step in building the foundation of your new role. As a quality manager in health care, knowing who else will be on your team to build and implement new quality measures can help you identify where to go when you run into any sticking points.
It’s also important not only to build allies but to have a good face-to-face relationship with everyone. With that, you have more leverage – building rapport helps to make for smoother policy changes or testing suggestions.
Identify your Champions of Change
Your Champions of Change aren’t always leadership. These individuals that will actually help implement or test a new procedure are often your most stellar staff member. They must be highly liked and highly respected by their colleagues. If they start to change their routine for the new procedure you’re testing, often their colleagues will follow suit.
You can find your Champions by observing the department. See how team members interact. Take note of who is speaking when everyone else is listening. Find who is already leading. If it’s hard to identify, talk to a few of the staff members or leadership team members to see what their thoughts are. Finding your champions will help make your new policies run a lot smoother.
Small Steps, Big Rewards
Speaking of new policies, when you jump into your new role, you might want to start by making a huge splash and improvement. However, we don’t recommend this approach. Thinking too big actually can backfire sometimes.
We suggest you start small – start in one department, with one team, on one shift with whatever policy you’d like to test. Often we can’t see potential negative outcomes of even the best-intended new policies, and starting small can mitigate any large negative effect.
Know When to Seek Outside Help
Getting outside training doesn’t mean you’re a failure at your job; it means you care about your new role and organization enough to want to succeed. You recognize you may not have all the answers, but you’d like them. Finding a guiding light during this transition time is a huge asset, but not everyone is so lucky to have a colleague who’s been in their shoes.
Thankfully, at Cynosure we’ve recognized this and created an on-demand course designed for new quality managers in health care that have been in their role for 6 months or less. New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job is taught by Dan Lanari, who has been exactly where you’re sitting before. He felt lost, frustrated, and like a failure at his new job. But he’s broken down everything he wishes he knew, so you don’t have to keep wondering.
If you’re new to your role and ready to get some proper training, you can learn more about the New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job and sign up for the course here!