sponsor innovation webinar€¦ · 2 million practicing health professionals 2,320 instructors...

Sponsor Innovation Webinar

Rachel D. Burnside, PhD, MBASr. Global Marketing Manager, HematologyBeckman Coulter

Mission Statement:

Save lives and reduce suffering by raising awareness of sepsis as a medical emergency.

www.sepsis.org

Sepsis Coordinator Network supports ongoing communication, education and network building among health professionals passionate about improved sepsis care. Resources include:

• Educational webinars that highlight sepsis best practices in a variety of healthcare settings

• Active discussion and peer support via an online forum

• A resource drive with information on topics including core measures, clinical practice guidelines, patient screening, identification tools, education resources and more

www.sepsiscoordinatornetwork.org

All active healthcare providers are welcome to join including:physicians, nurses, first responders, pharmacists, lab staff, etc.

Sponsors

POC Advisor™—Ensuring Early, Accurate & Prescriptive Care to Improve Sepsis OutcomesSteve Claypool, MD

May 1, 2019

1. Describe how POC Advisor’s sepsis module empowers sepsis coordinators to work confidently to improve outcomes, adding efficiencies and minimizing alert fatigue.

2. Explain how POC Advisor helps to reduce variability in care by making it easy for your teams to follow the policies & procedures you already have in place.

3. Discuss how POC Advisor leverages data and prescriptive alerts to improve performance and support accuracy in reporting.

Learning objectives of today’s webinar

2

Health Tax & Accounting Governance, Risk & Compliance Legal & Regulatory

EDUCATING

SUPPORTING

SERVING

INFORMING

1 millionmedical &

nursing students

2 millionpracticing health

professionals

2,320Instructors

4,300medical/nursing

schools

2.5 millionclinicians

187countries

34,000healthcare institutions and practices globally

50,000retail pharmacies

and payors

480+ millionclinical topic views per year

144 millionclinical decisions changed per year using UpToDate

Hospitals struggle with battling Sepsis

Protocols, Processes

Empowering Staff

Reporting, Bundle Compliance, Outcomes

Accurate Early Detection

Change management effort

Plan

DoStudy

Act

Sepsis Alliance resources

* Rhodes A, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Int Care Med 2017;43:304–77.* Dellinger R, Levy M, Rhodes A, Annane D, Gerlach H, Opal S, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165–228.* Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018 Apr 19;1–4.

Institute for Healthcare Improvement (IHI) collaborated to

create clinical guidance

Participating organizations

• European Society of Intensive Care Medicine

• Society of Critical Care Medicine

• International Sepsis Forum

Do the Sepsis Guidelines Work?

Following the Sepsis-2 / SSC treatment bundles, which are mostly in sync with CMS, is associated with improved patient outcomes for sepsis.

§ Meta-analysis of 50 observational studies: reduction in mortality [OR 0.66; 95% CI 0.61–0.72]*

* Damiani E, Donati A, Serafini G, Rinaldi L, Adrario E, Pelaia P, et al. Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS One 2015;10:e0125827.

.

The Bottom line:

Bundled Compliance Saves Lives

Forest plot (left) shows individual and overall ES of studies that evaluated

changes in mortality following the implementation of the performance

improvement program (k = 48)

Damiani, Elisa, et all. “Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality” PLoS One. 2015; 10(5) e0125827.

Hospitals struggle with battling Sepsis

Protocols, Processes

Empowering Staff

Reporting, Bundle Compliance,

Outcomes

Accurate Early Detection

What technology do you currently use for sepsis screening:

Poll – Question

• No sepsis screening

• No electronic alerting, paper screening

• EMR sepsis alerts provided by EMR system

• EMR sepsis alerts, home-grown

• Other third-party system

2019 Top List of Patient Safety Concerns

EHR solutions lack credibility.Clinicians ignore ~96% of notifications as they’re

typically wrong more than 90% of the time

ECRI INSTITUTE

“Clinicians are overloaded with electronic alerts, and that’s bad for patients.”

Luthra ShefaliThe Washington Post, 2016

Applying CDS alerting analysis to Sepsis

A meta-analysis of 8 sepsis alerting studies from 2015 showed no improvement in mortality.

Failure was primarily due to poor test specificity, with PPV < 50%, resulting in alert fatigue.*

* Makam, Anil N., Oanh K. Nguyen, and Andrew D. Auerbach. "Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review." Journal of hospital medicine 10.6 (2015): 396-402.

A.Fib Active Smoker

Acute Brain Injury Acute Coronary Syndrome

Acute Lymphocytic Leukemia Acute Myelogenous Leukemia

Acute Pancreatitis Acute Renal Failure

AIDS Alcohol Intoxication

Alcohol Withdrawal Alzheimer's Disease

AMI Antiretroviral Therapy

Aplastic Anemia Budd-Chiari Syndrome

Chemotherapy CHF

Chronic Renal Failure Cirrhosis

Cocaine Intoxication COPD

Corticosteroids Dementia

End Stage Renal Disease Hepatic Fai lure

Hepatitis HIV

Ischemic Bowel Ischemic Trauma

ITP Leukemoid Reaction

Myelodysplastic Syndrome Pancytopenia

Portal Hypertension Psychiatric Decompensation

Pulmonary Edema Pulmonary Embolism

Severe Liver Disease Severe Lung Disease

Severe Pain Severe Renal Failure

Sickle Cell Crisis Thrombocytopenia

Warfarin

Three-day Analysis, MedSurg & EDCOMORBIDITIES THAT CAUSED ABNORMALITIES

A list of medical

conditions that

would cause false-

positive alerts using

SIRS criteria

Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP. Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients. Am J Respir Crit Care Med. 2015;192(8):958-964.

Cumulative proportion of patients remaining on wards who met systemic inflammatory response syndrome (SIRS) criteria at least once during their ward stay before each time point.

POC Advisor is scientifically validatedJAMIA; Timeline 2016

50% Mortality

Systematic review of sepsis screening tools

Alberto L, Marshall AP, Walker R, Aitken LM. Screening for sepsis in general hospitalized patients: a systematic review. Journal of Hospital Infection. 2017 May 12

Reviewed all sepsis tools published between 1990-2016*

POC Advisor™ was the only study to significantly improve mortality and risk of death from sepsis

POC Advisor™ had the highest accuracy among all electronic tools

Timeline 2017

Why is POCA the Only Surveillance Tool Shown to Reduce Mortality?

VERY EARLY

DETECTION

§ 5.5 hrs and 7.8 hrs before

SIRS-based alerting at

large academic facility and

top IDN respectively

§ ABx administration ~6 hrs.

earlier at both

PREDICTIVE

ACCURACY

§ Sensitivity (99%+)

§ Specificity (97%+)

§ Minimal Alert Fatigue:

PPV is ~4X EHR SIRS

based solution

PRESCRIPTIVE

ALERTS

§ Pushed to care team in

real time

§ Bundle compliance

§ Timely execution of labs,

fluids, ABx, &

documentation with

reminders and escalation

Sepsis protocols

Every hospital develops order sets for how a patient should be treated.

Frequently it stops there.

Closing the gap on sepsis outcomes GOALS OF SEPSIS PROTOCOLS

• Delineate process steps for each potential stage in sepsis

• Empower clinical staff to ensure the patient receives the right care

• This will help standardize care

DemonstrationPOCA helps to enforce protocols by calling out each step with reminders and alerts, tailored to each clinicians’ work flow.

POC Advisor helps with reporting

Plan

DoStudy

Act

Benefits of point-of-care surveillance?

POC Advisor is Accurate and Early.

ü Provides confidence by delivering actionable alerts that do not cause alert fatigue

POC Advisor is Prescriptive. POC Advisor Aids Reporting.

ü Reduces variability in care by delivering advice to support existing facility protocols

ü Delivers reports that aid with process improvement to ensure bundle compliance and improve clinical outcomes

Thank you!

§ Request a demo http://bit.ly/POCadvisor§ To continue the conversation with our

Sepsis Clinical Team, email [email protected]

§ Visit our website: www.POCadvisor.com

TO LEARN MORE

WATCH YOUR EMAIL

“Sepsis Performance Improvement Plans - Assessing Gaps and

Opportunities” Roundtable Discussion

before the UW Medicine Sepsis Conference in Seattle, WA

Sunday, June 166 – 8:30 p.m.

Hosted by Wolters Kluwer, Health, a Sepsis Alliance Sepsis Coordinator

Network Sponsor

Q and A

www.SepsisItsAboutTime.org

http://www.sepsisitsabouttime.org/

© 2019 Beckman Coulter, Inc. All rights reserved.

Early Sepsis IndicatorA NEW BIOMARKER FOR THE EMERGENCY DEPARTMENT

Rachel D. Burnside, PhD, MBASr. Global Marketing Manager, Hematology

© 2019 Beckman Coulter, Inc. All rights reserved.31

Disclosure• Rachel Burnside is a paid employee of Beckman Coulter


Learning Objectives

• Appreciate the impact of sepsis and challenges to identify affected patients.

• Explain the rationale for measuring monocyte morphological heterogeneity for sepsis—termed monocyte distribution width, or MDW.

• Describe the potential benefits of Early Sepsis Indicator (ESId) in the Emergency Department.

Note: ESId is product name; MDW is the parameter name

© 2019 Beckman Coulter, Inc. All rights reserved.

Challenges of ED Sepsis Identification

© 2019 Beckman Coulter. All rights reserved. Beckman Coulter, the stylized logo, and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries. Danaher and its service marks are owned by Danaher Corporation and are used with permission.

Problem

Now there is a new tool for earlier detection.

Sepsis by the Numbers

PO-1955032018 Clinical & Financial

Solution


Clinical Challenges of Sepsis


ESId bridging the gapTypical Sepsis Care Pathway

Initial Triage:

Acuity Assessment &

Vital Signs

Routine Labs:

CBC w/Diff & Chemistry

Sepsis Labs:

Vary with Geography

Empiric antibiotics

qSOFA:• Altered mental status• Tachypnea• Hypotension

SIRS• Temperature >38.3 or <36ºC• Tachycardia• Tachypnea or decreased PaCO2• WBC count >12000/mm3 or

<4000/mm3 or >10% bands

Signs & symptoms suggest possible

sepsis?


Why Monocytes Matter:Monocytes Are Key Effector Cells In Sepsis

Increased MDW

Morphological variability

Increased functional heterogeneity of monocytes in sepsis

Sepsis-related Immunosuppression Pro-inflammatory State

•Cytokine Storm•Overwhelming Inflammation•Organ failure


MDW Is Measured By Extended Volume Range

• Monocyte volume values are accumulated on an extended volume range

• Accurately measures monocyte populations with cell volumes that exceed the five-part differential measuring range


MDW Improves Value of the WBC Results for Sepsis Detection

MDW alone WBC + MDW


ESId Used With Current Standard Of CareEarly Sepsis Indicator adds value to the current standard of care. Combined with WBC count, Early Sepsis Indicator augments clinical suspicion of sepsis.1,2

1. UniCel DxH Series with System Manager Software. Early Sepsis Indicator Application Addendum. PN C05728AA. March 2018.2. Sepsis Clinical Accuracy Performance on DxH 800 Test Summary Report. PN C07352. March 2018.

Further increased suspicion of sepsis or developing sepsis, 63.5%WBC Abnormal

Increased clinical suspicion of Sepsis or underlying medical condition, 24.3%WBC Normal

Increased clinical suspicion of underlying medical condition, 19.2%WBC Abnormal

Lower suspicion of sepsis 2.9%WBC Normal

MDW below cutoff

MDW at or

above cutoff

Change in post-test probability from a pre-test probability of 17.8%


Workflow Remains Unchanged

1 3 4 5

Lab results show elevated

MDW and abnormal WBC

REMISOL Advance

Decision rules triggered

Alert sent to clinician to the

presence or risk of developing sepsis

REMISOL Advance is a trademark or registered trademark of Normand-Info SAS in the United States and other countries. Used under license.

CBC-diff

ordered

from the ED

2


Early Sepsis Indicator Empowers Clinicians

• Actionable insights that help accelerate critical decisions

When used with standard of care• Potential clinical and health-

economics benefits of faster clinical decision-making

KNOW SOONER

IDENTIFY SEPSIS MORE CONFIDENTLY


Summary

• Sepsis is a deadly and costly condition that is often challenging to identify.

• Early Sepsis Indicator (ESId) is the only FDA cleared hematology-based

parameter, known as MDW, specifically indicated for sepsis.

• ESId has been shown in multicenter trial to exhibit significantly improved post-

test probabilities of sepsis risk when assessed together with current standard

of care, improving the performance of the WBC and SIRS.

• ESId results are provided automatically on CBC-diff results for adult patients in

the ED with no additional test to order or impact to current workflow.

© 2019 Beckman Coulter, Inc. All rights reserved. Beckman Coulter, the stylized logo, and the Beckman Coulter product and service marks mentioned herein are trademarks or registered trademarks of Beckman Coulter, Inc. in the United States and other countries.

Thank youRachel D. Burnside, PhD, MBASr. Global Marketing Manager, HematologyEmail: [email protected]: 305-389-0420

mailto:[email protected]


References: Sepsis by the Numbers• References:

• 1. Sepsis Alliance. “Critical Fact Sheet.” Sepsis.org. Accessed January 15, 2018.

• 2. Vidant Beaufort Hospital “The third-leading cause of death: sepsis” http://www.thewashingtondailynews.com/2017/07/08/the-third-leading-cause-of-death-sepsis/, July 8, 2017. Accessed March 19, 2018.

• 3. Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, Jimenez E, Mohan A, Khan RA, Whittle J, Jacobs E, Nanchal R. Nationwide trends of severe sepsis in the twenty first century (2000-2007) Chest. 2011;16:1223–1231. doi: 10.1378/chest.11-0352. [PubMed] [Cross Ref]

• 4. Hall MJ, Williams SJ, DeFrances CJ, Golosinsky A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. http://www.cdc.gov/nchs/data/databriefs/db62.pdf [PubMed]

• 5. Perman, S. M., Goyal, M., & Gaieski, D. F. (2012). Initial Emergency Department Diagnosis and Management of Adult Patients with Severe Sepsis and Septic Shock. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20, 41. http://doi.org/10.1186/1757-7241-20-41

• 6. Torio C, Moore B. “National Inpatient Hospital Costs: The Most Expensive Conditions by Payer.” http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf, May 2016. Accessed January 15, 2018.

• 7. Angus, DC et al. “Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.” Crit Care Med, vol. 29, 2001, pp. 1303-10.

• 8. Fingar K. “Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013.” https://www.hcup-us.ahrq.gov/reports/statbriefs/sb196-Readmissions-Trends-High-Volume-Conditions.jsp, November 2015. Accessed January 15, 2018.

• 9. Kumar A, Roberts D, Wood KE et al. “Duration of Hypotension Before Initiation of Effective Antimicrobial Therapy is the Critical Determinant of Survival in Human Septic Shock.”Crit Care Med, vol. 34. 2006, pp. 1589–96.

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb196-Readmissions-Trends-High-Volume-Conditions.jsp

Q and A

www.SepsisItsAboutTime.org

http://www.sepsisitsabouttime.org/

Maternal Sepsis Day is May 15

Registration : www.sepsiswebinar.org

Speakers:Lori Olvera, DNP, RNC-OB, EFM-CPerinatal Educator Sutter Medical Center

Katarina Lannér-Cusin, MD, FACOG Medical Director Women’s Services, Sutter HealthAlta Bates Summit Medical Center

Graciela Eldridge, ADN, RN, Maternal Sepsis Survivor

Maternal Sepsis Webinar May 15 at 2-3:30 pm ET

The information in this webinar is intended for educational purposes only. The presentations

and content are the opinions, experiences, views of the specific authors/presenters and

are not statements of advice or opinion of Sepsis Alliance. The presentation has not been prepared, screened, approved, or endorsed by

Sepsis Alliance.

Thank youFounding Sponsor: Network Sponsors:

sponsor innovation webinar€¦ · 2 million practicing health professionals 2,320 instructors...

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