by Dr. Kenneth H. Cohn
As President Obama recently celebrated the heroism of the Navy SEALS who neutralized Osama bin Laden, I thought of people in the 40 states where I have worked who make me proud to be a physician.
The first who came to mind was Jeff Fried, medical director of the ICU at Cottage Hospital in Santa Barbara, Calif. In 2004, as nearly half the patients died who presented with overwhelming bacterial infection (sepsis), he asked, "Why can't we do better?"
Dr. Fried realized that the implementation of a "Slay Sepsis Campaign" would require multi-disciplinary cooperation. He became the physician champion , committed to developing a sepsis protocol, even though he had no experience developing and implementing such a complex set of rules.
He evaluated his hospital's strengths:
- Committed nursing and ancillary staff, eager to improve patient quality and safety
- A physician community with high standards for care
- Medical and surgical residency programs which allow physicians to be available immediately to treat septic patients
- Trauma service and cardiac catheterization programs that could serve as models for interdisciplinary cooperation
- Not-for-profit community hospital with a Board of Directors committed to improving quality standards and clinical outcomes for the community
And the barriers to implementing a sepsis protocol:
- A busy Emergency Department (ED), averaging approximately 40,000 annual visits, requiring a better system of triage to incorporate the needs of septic patients who present with subtle signs
- The need for more rapid identification and treatment of patients with sepsis within one hour of presentation
- Laboratory turn around times that were too slow for key tests, such as lactate and complete blood count with differential (CBC)
- Pharmacy delivery times that were too slow for antibiotics and other critical medications
- Slow transfers from ED to the Critical Care Units (ICUs), where patients receive most of their care
- Need for new technology, requiring both capital expenditures and physician and nurse training
- Need for extensive education of medical staff, residents, ED nurses, critical care nurses, respiratory therapists, pharmacy and laboratory personnel
Some steps that became part of his protocol include:
- Specially marked tube top that identifies blood specimens from the sepsis protocol, that go to the front of the queue, to overcome slow turnaround times
- Module attached to the blood-gas machine to measure arterial lactate levels within 10 minutes
- Sepsis cart in the Medical ICU that contains everything patients need, to keep the patient's nurse at the bedside as much as possible
Within two years, the annual death rate from sepsis decreased from 44 percent to 24 percent without a single drug being changed. The results were stunning to the medical staff, the nursing staff, administration and the Board of Directors. However, two years later, the death rate climbed to 27 percent, spurring alarm. The medical director pulled the entire team together and spent a weekend in a Lean-guided approach, using root-cause analyses and a just-in-time approach to minimize waste and optimize efficiency and effectiveness.
The team identified changes that were necessary, implemented the changes, and reduced the annual sepsis mortality rate to less than 20 percent. An estimated 200 people are alive today as a result of the process improvements, who would not have been expected to survive if hospital personnel had not studied and improved the care pathway.
Dr. Fried commented that the best part of the Lean process was gathering everyone in the room at the same time, which allowed people to see the process as a whole and increased peer-group pressure to be part of the change process.
It was Dr. Fried who inspired me to write my latest book, Getting It Done . What he accomplished would otherwise have been published only in the Journal of Critical Care Medicine as an abstract, hardly a site that hospital leaders and physician executives routinely peruse. To me, his pathway will always represent a hero's journey.
Ken is a practicing general surgeon/MBA and CEO of HealthcareCollaboration.com , who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform. His upcoming book, Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success , is scheduled to be published late May 2011. Please learn more by visiting http://gettingitdonebook.com .
by Dr. Kenneth H. Cohn
The first who came to mind was Jeff Fried, medical director of the ICU at Cottage Hospital in Santa Barbara, Calif. In 2004, as nearly half the patients died who presented with overwhelming bacterial infection (sepsis), he asked, "Why can't we do better?"
Dr. Fried realized that the implementation of a "Slay Sepsis Campaign" would require multi-disciplinary cooperation. He became the physician champion , committed to developing a sepsis protocol, even though he had no experience developing and implementing such a complex set of rules.
He evaluated his hospital's strengths:
And the barriers to implementing a sepsis protocol:
Some steps that became part of his protocol include:
Within two years, the annual death rate from sepsis decreased from 44 percent to 24 percent without a single drug being changed. The results were stunning to the medical staff, the nursing staff, administration and the Board of Directors. However, two years later, the death rate climbed to 27 percent, spurring alarm. The medical director pulled the entire team together and spent a weekend in a Lean-guided approach, using root-cause analyses and a just-in-time approach to minimize waste and optimize efficiency and effectiveness.
The team identified changes that were necessary, implemented the changes, and reduced the annual sepsis mortality rate to less than 20 percent. An estimated 200 people are alive today as a result of the process improvements, who would not have been expected to survive if hospital personnel had not studied and improved the care pathway.
Dr. Fried commented that the best part of the Lean process was gathering everyone in the room at the same time, which allowed people to see the process as a whole and increased peer-group pressure to be part of the change process.
It was Dr. Fried who inspired me to write my latest book, Getting It Done . What he accomplished would otherwise have been published only in the Journal of Critical Care Medicine as an abstract, hardly a site that hospital leaders and physician executives routinely peruse. To me, his pathway will always represent a hero's journey.
Ken is a practicing general surgeon/MBA and CEO of HealthcareCollaboration.com , who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform. His upcoming book, Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success , is scheduled to be published late May 2011. Please learn more by visiting http://gettingitdonebook.com .