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Sepsis Initiative Sparks Collaboration Between Virginia Nursing Home and Hospital

Inova Mount Vernon Hospital and Mount Vernon Healthcare Center (MVHC), located in Alexandria, Va., share a similar name and serve many of the same patients and families. But until recently, they were not always sharing what matters most: consistent communication about their patient population.

Now, that’s changing. Last year, both organizations signed up for Health Quality Innovators’ (HQI’s) Stopping Sepsis initiative. As a result, they have built a stronger relationship and opened the lines of communication for the benefit of their patients.

According to Heather Whyte, infection preventionist at MVHC, roughly 70% of the facility’s skilled nursing residents arrive at the center after being discharged from Inova Mount Vernon Hospital. Too many of those patients were being readmitted with a sepsis diagnosis. To reduce their sepsis rates, Whyte knew they needed to form a more effective partnership with the hospital.

CONNECTING TO IMPROVE QUALITY
HQI helped connect Whyte with Inova Mount Vernon and both facilities attended a cross-setting meeting focused on sepsis prevention. Following this meeting, hosted by HQI and the Virginia Hospital & Healthcare Association, the two facilities began meeting monthly.

John Lawrence, sepsis coordinator/stroke coordinator for Inova Mount Vernon Hospital, was very responsive and immediately saw the benefits of a partnership. They took turns hosting so that each had a chance to tour the other’s facility. Alternating the location also made it easier for senior leaders to participate in at least one meeting.

“During our meetings, there’s a lot of good dialogue about what we can both do to improve patient hand-offs. Our monthly meetings are never one sided and everyone has been open to new ideas and approaches. We are all committed to a strong partnership and to reducing sepsis mortality,” Lawrence said.

During one of their first meetings, Lawrence leveraged Inova’s EHR data to create reports including every patient who was transferred from MVHC with a diagnosis of sepsis. Everyone received a copy of the report prior to the meeting and they used their time together to examine each sepsis admission, identify contributing factors and look for opportunities to improve.

“Before John shared this data, we did not know what happened to patients after they left our facility. The hospital has access to data and resources that are not available to our nursing facility. This information is helping us improve our processes and the care we provide to our residents,” Whyte said.

TAKING ACTION
Over time, the meetings have nurtured a strong, successful collaboration that has changed the way the nursing staff communicate. Examples include:

  1. Communicating clearly: Nursing home staff use the SBAR tool and say “possible sepsis” when they are interacting with the hospital about changes in a resident’s status. This practice is reinforced in the Seeing Sepsis tools HQI provides to participating nursing homes.
  2. Asking questions: Open lines of communication mean that nursing home staff call the hospital if they have questions about the plan of care, medication schedule, whether antibiotics should be continued, etc.
  3. Speaking up: Real-time feedback is shared when the discharge summary is not clear or if other changes are needed to improve patient handoffs. Inova found that important patient information was not always shared in a timely manner.
  4. Spreading best practices: Inova shared resources to help screen for sepsis. Now, Mount Vernon Healthcare Center uses the screening tool during every shift.

The benefits of collaboration do not end with improving care for patients with sepsis. Lawrence and Whyte believe that better communication improves care for all and can reduce readmissions, strengthen medication safety and lead to better outcomes.

SEEING SEPSIS
In addition to its partnership with Inova, MVHC is taking additional steps to protect patients from sepsis. They introduced the Seeing Sepsis resources provided by HQI, including patient education brochures, posters, video and sepsis 100 pocket cards. The sepsis algorithm, used in coordination with POLST (Provider Orders for Life-Sustaining Treatment), guide decisions about whether a hospital visit respects the patient’s wishes.

Preventing sepsis and reducing its complications is a big job and MVHC was pleased to have support from HQI and the engagement of the nursing home staff, including its director of nursing and the administrator.

“We have a shared philosophy of caring for our residents as if they were members of our family. We are here for our community and want the best possible outcome for patients who need our services,” Whyte said.

BEST PRACTICES FOR HOSPITAL SUCCESS

What can hospitals learn from Inova Mount Vernon’s experience? Lawrence believes that quality improvement projects, including those focused on sepsis, are more likely to succeed when:

  1. Data is shared: Inova shares data and trends with front-line staff. This engages them in the work and lets them know what’s working and what’s not.
  2. Teams are motivated: Lawrence checks in with teams both when things go badly and when things are going well. Praise is an important part of quality improvement.
  3. Leadership is engaged: The hospital’s leadership team fully supports improvement initiatives, from corporate leaders at the top of the organization down to the administrators at the unit level who keep staff accountable.

In addition to participating in HQI’s Stopping Sepsis initiative, Inova Mount Vernon Hospital is also engaged in the Hospital Improvement Innovation Network led by Premier.

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