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Mapping Patient Flow to Better Manage Severe Hospital Infections and Sepsis

ID: SM-165


15 Info Graphics

4 Data Graphics

24 Narratives

Pages: 42

Published: Pre-2019

Delivery Format: Shipped


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Infections, and in particular the septic response to infections, are rising at an alarming rate in healthcare settings around the globe. This report examines this trend by analyzing the flow of patients with severe infections leading to sepsis through six top U.S. academic medical centers. Data was gathered through 19 interviews with expert physicians within the disciplines of emergency care, internal medicine, infectious disease and critical care. These experts offer their views on the critical points in the patient pathway and on ways to improve management of these patient populations to reach desired outcomes. Physician insights are presented in a 44-page report and through an integrated patient flow map, showing an illustrated view of patient movements through the common pathways that exist across each of the medical centers for each phase of care: Emergency Department, General Inpatient and Intensive Care Unit. This map highlights common points of decision-making and disease onset or progression.

Industries Profiled:
Biotech; Pharmaceutical; Medical Device; Health Care; Chemical

Companies Profiled:
Amgen; AstraZeneca; Baxter Healthcare; Cooper Health System; Eli Lilly; Genentech; GlaxoSmithKline; Memorial Hospital; North Shore University Hospital; Pfizer; Pharmacia; University of Pennsylvania Medical Center; University of Pittsburgh Medical Center; Yale-New Haven Hospital

Study Snapshot

Mapping Patient Flow to Better Manage Severe Hospital Infections and Sepsis provides organizations involved in the healthcare industry with insight into the management of patients with severe infections, and specifically the infection response known as sepsis at six leading academic medical centers. Chapters cover how and where patients commonly acquire severe infections and sepsis and their common movements through the hospital to identify care improvement opportunities.

The report, 44 pages—including an integrated map showing the common patient pathways across all centers—is based on in-depth interviews with leading physicians at six leading U.S. academic medical centers. It contains 19 graphics and 24 expert narratives, making it an accessible, yet rich resource. For example, snapshots are offered with information on each medical center such as average lengths of stay for each phase of care.

Key Findings

Best Practices LLC identified several key findings after analyzing the patient flow in six leading academic medical facilities. A sample of key findings include:

  • When it comes to dealing with sepsis, like many infections, time is essential and progression unpredictable. Physicians recognize that successful sepsis treatment must be rapid – provided within a matter of hours not days. Treatment must also be sensitive to the unpredictable nature of the disease. Physicians emphasized the importance of monitoring on the floors and in the ED, recognition of early signs of the disease, and taking quick action to reduce the likelihood of progression. They also advocated the development of patient risk profiles to identify those most prone to infection, creating treatment algorithms, obtaining patient records, starting antibiotic therapy, processing diagnostic tests more rapidly, and procuring consultations from ancillary specialists.
  • Sepsis patients are found everywhere, and moved everywhere. Sepsis is found in all areas of the hospital and patients arrive from many different outside sources, particularly nursing homes and extended care facilities. Within the hospital, patients are moved from one area to the next frequently with large amounts of waiting time between moves (i.e. from ED to floors to ICU).
Getting the patient stabilized and started on antibiotics is the goal of the ED staff when dealing with sepsis patients. Once patients are out of immediate danger and a profile has been developed to assess various risk factors, the decision is made to move the patient to the floor or the ICU. After a battery of diagnostic procedures and medical consultations, septic patients are almost always admitted to either the floors or the Intensive Care Unit (ICU), depending on the level of acuity and respiratory stability. Under rare circumstances is the patient released from the ED, unless there are pre-determined orders not to resuscitate, in which case the patient is made comfortable and returned to an extended care facility.

One interesting finding is that a sepsis patient can remain in the ED anywhere from 4 to 24 hours. The extended duration in the ED is either a function of bed availability or the need for emergency care. At these leading hospitals, the medical equipment and treatment options are comparable in the ICU and the ED, but staffing levels are different. Nursing ratios are higher in the ICU to watch patients more closely. Some interviewed physicians noted, though, that in the ED attending physicians are on duty at night, while the ICU is more likely to be staffed by residents or interns after regular working hours.

Table of Contents

Report Overview & Medical Center Profiles
  • Project Methodology
  • Benchmark Class
  • Report Structure and Organization Page
  • Medical Center Profiles

Key Findings

Patient Flow Analysis

  • Arrival
  • Triage
  • ED Assessment
  • General Inpatient Floor
  • Intensive Care Unit
  • Decision Points

List of Charts & Exhibits

Stages of Sepsis
  • Internist Role
  • Typical Sepsis Patient in the ED
  • Inpatient Treatment Options
  • Common Signs of Sepsis in ED
  • Criteria for Requesting an ICU Transfer
  • Symptoms Calling for Fast Track ED Status
  • Hospital Discharge Criteria
  • Diagnostics Ordered by ED Physicians
  • Typical Sepsis Patient in the ICU
  • Criteria for ICU Transfer
  • Diagnostics Ordered by ICU Physicians
  • Types of Sepsis Inpatients
  • Role of the Infectious Disease Physician
  • Criteria for Inpatient Admission to General Floor
  • ED Decision Points
  • Most Common Infections in Sepsis Inpatients
  • ICU Decision Points
  • Inpatient Medicine Decision Points