Queensland adult and paediatric sepsis Collaborative

1. Queensland adult and paediatric sepsis Collaborative Michael Rice Director, Patient Safety & Quality Improvement Service

2. Why sepsis is a problem? • Sepsis is a silent killer that is difficult to diagnose • 5 x more likely to die of sepsis than a heart attack or stroke • 2 x more likely to die of sepsis than prostate cancer or stroke • 60% of Australians have not heard of it • 14% of Australians can name a symptom

3. Sepsis incidence is rising Episodes 22,000 4,400 Sepsis Principal Diagnosis (LHS) 20,000 4,000 Any sepsis additional diagnosis, other PD (LHS) In-hospital mortality level (RHS) 18,000 3,600 16,000 3,200 14,000 2,800 12,000 2,400 10,000 2,000 8,000 1,600 6,000 1,200 4,000 800 2,000 400 0 0 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Note: inpatient data for public facilities only, some episodes are privately financed (includes episode changes). Source: QHAPDC data extraction 24-Aug-2018

4. SAC 1 sepsis incidents • 42 SAC 1 sepsis incidents, 2016 – 2018 • 33 of these admitted via ED • 82% were adults • 18% were paediatric • 80% of all SAC1 events were reported by our larger hospitals (have most volume) • 20% of SAC1 events were in rural and remote areas

5. Coronial inquests • 2010 – 2018 :9 coronial inquests (further 2 pending) • Early recognition and treatment a recurring theme in all cases • State Coroner has a keen interest in this work as it links to issues around the deteriorating patient

6. Cost to the system

7. What are we doing about it? • Developed and tested a best practice screening tool & treatment bundle at Gold Coast University Hospital (GCUH) ED • 16 level 4-6 CSCF hospital emergency departments enrolled in the Collaborative • Launched 30-31 August 2018 and concludes December 2019 - using the Institute for Healthcare Improvement’s (IHI) methodology • Strategic links with statewide clinical networks (QEDSAP and ICU in particular)

8. What is a Breakthrough Collaborative? • The Institute for Healthcare Improvement* (IHI) developed the Breakthrough Series Collaborative methodology to help health care organizations make "breakthrough" improvements in quality while reducing costs. *IHI is a US based world recognized innovator, convener, and leader in healthcare improvement . Their vision is for everyone to have the best care and health possible. For more information go to http://www.ihi.org/

9. What is a Breakthrough Collaborative? • short term learning system (12 -18) months • brings a large number of teams together to seek improvement in a focused topic area • applies the IHI Model for Improvement • implementation of a best practice bundle (often but not essential) • all teach/all learn • teams of 4-6 from each hospital attend x3 workshops with additional members working on improvements at the hospital

10. Conditions for a Collaborative • Topic • Ripe • Backed by evidence/expert opinion • Addresses a gap between current practice and best practice • Will • Ideas • Execution

11. Does it work?

12. Is it scalable?

13. Is it sustainable?

14. How is it structured? • three two day workshops (Learning Sessions) where teams learn about and apply improvement science • action Periods in between to test ideas for change in their own environment

16. Collaborative Aim • Adults • reduce mortality from sepsis by 10% • reduce median length of stay by one day • reduce median ICU LOS by 10% • Paediatrics • reduce median length of stay by one day • reduce median ICU LOS by >10%

17. Adult Screening Tool

18. Paediatric Screening Tool