Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

IIR 19-168 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

IIR 19-168
Building a Learning Healthcare System to Understand and Improve Sepsis Outcomes in the VA TeleICU Network
James M Blum MD
Decatur, GA
Funding Period: July 2020 - June 2024

Abstract

Background: Sepsis, the body's overwhelming systemic response to infection, strikes more than 1 million patients annually in the United States and is known to impact over 48,000 Veterans every year. Over the past decade, sepsis survival has continued to improve through a better understanding of effective therapies, early intervention, and prophylaxis. This has been seen in the private sector and VA with inpatient mortality dropping from 15% in 2008 to 10% in 2012. However, despite this improvement, a patient with sepsis may have up to a 50% increased risk of death at 30 days depending on the hospital to which he/she is admitted in the VA system. Significance/Impact: This proposal is specifically designed to address three priority domains of the HSR&D Service - Healthcare Informatics, Quality and Safety of Health Care, and Virtual Care. Through the unique combination of these three domains we plan to address two significant limitations in understanding sepsis in the VA; 1) that existing reports may or may not provide insight into the distinguishing characteristics of the patients that died with sepsis in what are thought to be similar VA ICUs, and 2) in these reports there are multiple interventions known or suspected to improve outcomes with varying levels of efficacy about which little or no information is offered. Innovation: We can use a novel data source (TeleICU) to directly identify the patient level factors associated with negative outcomes in the septic patient population, quantify the practices of high and low performing units, and subsequently improve the care provided to septic patients in VA ICUs using this information. Specific Aims: Aim #1: Characterize and identify patient and ICU level factors associated with negative sepsis outcomes. Aim #2: Qualitatively examine sepsis practices at high and low performing sites (defined in SA1), including documented protocols, clinical workflows, and TeleICU support and consultation with the goal of identifying future targets for improvement. Aim #3: Evaluate the incidence of previously unmonitored management strategies and their impact on outcomes cited in SA1a (ICU mortality as primary outcome) in VA sepsis patients. Methodology: We will conduct a mixed methods investigation by merging data from the TeleICU and Corporate Data Warehouse to first identify high and low performing ICUs in the treatment of sepsis. We will then perform an ethnographic investigation of 3 high and low performing ICUs in the treatment of sepsis. Simultaneously, we will examine the management of hypotension, the use of lung protective ventilation, and the use and efficacy of antibiotics in septic patients in the ICU. Next Steps/Implementation: We will develop dashboards that provide in real-time, to local clinicians, updates on septic patients in the ICU that provide information regarding the state of septic patients and their compliance with metrics that are associated with improved outcomes. We anticipate this will improve the overall survival of sepsis patients and potentially reduce the cost of care.

NIH Reporter Project Information: https://projectreporter.nih.gov/project_info_description.cfm?aid=9950526

PUBLICATIONS:
None at this time.

DRA: None at this time.
DRE: None at this time.
Keywords: Guideline Development and Implementation, Organizational Structure, Outcomes - System, Quality Improvement
MeSH Terms: None at this time.

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.