Why Hospitals Should Act Now to Create Clinical AI Departments

Why Hospitals Should Act Now to Create Clinical AI Departments
John Frownfelter, MD, FACP, Chief Medical Information Officer at Jvion

A century ago, X-rays transformed medicine forever. For the first time, doctors could see inside the human body, without invasive surgeries. The technology was so revolutionary that in the last 100 years, radiology departments have become a staple of modern hospitals, routinely used across medical disciplines.

Today, new technology is once again radically reshaping medicine: artificial intelligence (AI). Like the X-ray before it, AI gives clinicians the ability to see the unseen and has transformative applications across medical disciplines. As its impact grows clear, it’s time for health systems to establish departments dedicated to clinical AI, much as they did for radiology 100 years ago.

Radiology, in fact, was one of the earliest use cases for AI in medicine today. Machine learning algorithms trained on medical images can learn to detect tumors and other malignancies that are, in many cases, too subtle for even a trained radiologist to perceive. That’s not to suggest that AI will replace radiologists, but rather that it can be a powerful tool for aiding them in the detection of potential illness — much like an X-ray or a CT scan. 

AI’s potential is not limited to radiology, however. Depending on the data it is trained on, AI can predict a wide range of medical outcomes, from sepsis and heart failure to depression and opioid abuse. As more of patients’ medical data is stored in the EHR, and as these EHR systems become more interconnected across health systems, AI will only become more sensitive and accurate at predicting a patient’s risk of deteriorating.

However, AI is even more powerful as a predictive tool when it looks beyond the clinical data in the EHR. In fact, research suggests that clinical care factors contribute to only 16% of health outcomes. The other 84% are determined by socioeconomic factors, health behaviors, and the physical environment. To account for these external factors, clinical AI needs external data. 

Fortunately, data on social determinants of health (SDOH) is widely available. Government agencies including the Census Bureau, EPA, HUD, DOT and USDA keep detailed data on relevant risk factors at the level of individual US Census tracts. For example, this data can show which patients may have difficulty accessing transportation to their appointments, which patients live in a food desert, or which patients are exposed to high levels of air pollution. 

These external risk factors can be connected to individual patients using only their address. With a more comprehensive picture of patient risk, Clinical AI can make more accurate predictions of patient outcomes. In fact, a recent study found that a machine learning model could accurately predict inpatient and emergency department utilization using only SDOH data.

Doctors rarely have insight on these external forces. More often than not, physicians are with patients for under 15 minutes at a time, and patients may not realize their external circumstances are relevant to their health. But, like medical imaging, AI has the power to make the invisible visible for doctors, surfacing external risk factors they would otherwise miss. 

But AI can do more than predict risk. With a complete view of patient risk factors, prescriptive AI tools can recommend interventions that address these risk factors, tapping the latest clinical research. This sets AI apart from traditional predictive analytics, which leaves clinicians with the burden of determining how to reduce a patient’s risk. Ultimately, the doctor is still responsible for setting the care plan, but AI can suggest actions they may not otherwise have considered.

By reducing the cognitive load on clinicians, AI can address another major problem in healthcare: burnout. Among professions, physicians have one of the highest suicide rates, and by 2025, the U.S. The Department of Health and Human Services predicts that there will be a shortage of nearly 90,000 physicians across the nation, driven by burnout. The problem is real, and the pandemic has only worsened its impact. 

Implementing clinical AI can play an essential role in reducing burnout within hospitals. Studies show burnout is largely attributed to bureaucratic tasks and EHRs combined, and that physicians spend twice as much time on EHRs and desk work than with patients. Clinical AI can ease the burden of these administrative tasks so physicians can spend more time face-to-face with their patients.

For all its promise, it’s important to recognize that AI is as complex a tool as any radiological instrument. Healthcare organizations can’t just install the software and expect results. There are several implementation considerations that, if poorly executed, can doom AI’s success. This is where clinical AI departments can and should play a role. 

The first area where clinical AI departments should focus on is the data. AI is only as good as the data that goes into it. Ultimately, the data used to train machine learning models should be relevant and representative of the patient population it serves. Failing to do so can limit AI’s accuracy and usefulness, or worse, introduce bias. Any bias in the training data, including pre-existing disparities in health outcomes, will be reflected in the output of the AI. 

Every hospital’s use of clinical AI will be different, and hospitals will need to deeply consider their patient population and make sure that they have the resources to tailor vendor solutions accordingly. Without the right resources and organizational strategies, clinical AI adoption will come with the same frustration and disillusionment that has come to be associated with EHRs

Misconceptions about AI are a common hurdle that can foster resistance and misuse. No matter what science fiction tells us, AI will never replace a clinician’s judgment. Rather, AI should be seen as a clinical decision support tool, much like radiology or laboratory tests. For a successful AI implementation, it’s important to have internal champions who can build trust and train staff on proper use. Clinical AI departments can play an outsized role in leading this cultural shift.  

Finally, coordination is the bedrock of quality care, and AI is no exception. Clinical AI departments can foster collaboration across departments to action AI insights and treat the whole patient. Doing so can promote a shift from reactive to preventive care, mobilizing ambulatory, and community health resources to prevent avoidable hospitalizations.

With the promise of new vaccines, the end of the pandemic is in sight. Hospitals will soon face a historic opportunity to reshape their practices to recover from the pandemic’s financial devastation and deliver better care in the future. Clinical AI will be a powerful tool through this transition, helping hospitals to get ahead of avoidable utilization, streamline workflows, and improve the quality of care. 

A century ago, few would have guessed that X-rays would be the basis for an essential department within hospitals. Today, AI is leading a new revolution in medicine, and hospitals would be remiss to be left behind.


About  John Frownfelter, MD, FACP

John is an internist and physician executive in Health Information Technology and is currently leading Jvion’s clinical strategy as their Chief Medical Information Officer. With 20 years’ leadership experience he has a broad range of expertise in systems management, care transformation and health information systems. Dr. Frownfelter has held a number of medical and medical informatics leadership positions over nearly two decades, highlighted by his role as Chief Medical Information Officer for Inpatient services at Henry Ford Health System and Chief Medical Information Officer for UnityPoint Health where he led clinical IT strategy and launched the analytics programs. 

Since 2015, Dr. Frownfelter has been bringing his expertise to healthcare through health IT advising to both industry and health systems. His work with Jvion has enhanced their clinical offering and their implementation effectiveness. Dr. Frownfelter has also held professorships at St. George’s University and Wayne State schools of medicine, and the University of Detroit Mercy Physician Assistant School. Dr. Frownfelter received his MD from Wayne State University School of Medicine.


Transforming Care Delivery Through AI-Powered Predictive Surveillance

Transforming care delivery through AI-powered predictive surveillance
John Langton, Ph.D. Director of Applied Data Science, Wolters Kluwer, Health

Since the onset of the COVID-19 pandemic, hospitals and health systems have pushed forward with innovative technology solutions with great expediency and proficiency. Healthcare organizations were quick to launch telehealth solutions and advance digital health to maintain critical patient relationships and ensure continuity of care. Behind the scenes, hospitals and health systems have been equally adept at advancing technology solutions to support and enhance clinical care delivery. This includes adopting clinical surveillance systems to better predict and prevent an escalation of the coronavirus. 

Clinical surveillance systems use real-time and historical patient data to identify emerging clinical patterns, allowing clinicians to intervene in a timely, effective manner. Over time, these clinical surveillance systems have evolved to help healthcare organizations meet their data analytic, surveillance, and regulatory compliance needs. The adaptability of these systems is evidenced by their expanded use during the pandemic. Healthcare organizations quickly pivoted to incorporate COVID-19 updates into their clinical surveillance activities, providing a centralized, global view of COVID-19 cases. 

To gain insight into the COVID-19 crisis, critical data points include patient age, where the disease was likely contracted, whether the patient was tested, and how long the patient was in the ICU, among other things. Surveillance is also able to factor in whether patients have pre-existing conditions or problems with blood clotting, for example. This data trail is helping providers create a constantly evolving coronavirus profile and provides key data points for healthcare providers to share with state and local governments and public health agencies. In the clinical setting, the data are being used to better predict respiratory and organ failure associated with the virus, as well as flag COVID-19 patients at risk for developing sepsis.

What’s driving these advancements? Clinical surveillance systems powered by artificial intelligence (AI). By refining the use of AI for clinical surveillance, we can proactively identify an expanding range of acute and chronic health conditions with greater speed and accuracy. This has tremendous implications in the clinical setting beyond the current pandemic. AI-powered clinical surveillance can save lives and reduce costs for conditions that have previously proven resistant to prevention.

Eliminating healthcare-associated infections

Despite ongoing prevention efforts, healthcare-associated infections (HAIs) continue to plague the US healthcare system, costing up to $45 billion a year. According to the Centers for Disease Control and Prevention (CDC), about one in 31 hospitalized patients will have at least one HAI on any given day.  AI can analyze millions of data points to predict patients at-risk for HAIs, enabling clinicians to respond more quickly to treat patients before their infection progresses, as well as prevent spread among hospitalized patients. 

Building trust in AI

While the benefits are clear, challenges remain to the widespread adoption and use of AI in the clinical setting. Key among them is a lack of trust among clinicians and patients around the efficacy of AI. Many clinicians remain concerned over the validity of the data, as well as uncertainty over the impact of the use of AI on their workflow. Patients, in turn, express concerns over AI’s ability to address their unique needs, while also maintaining patient privacy. Hospitals and health systems must build trust among clinicians and patients around the use of AI by demonstrating its ability to enhance outcomes, as well as the patient experience.


3 keys to building trust in AI

Building trust among clinicians and patients can be achieved through transparency, expanding data access, and fostering focused collaboration.

1. Support transparency 

Transparency is essential to the successful adoption of AI in the clinical setting. In healthcare, just giving clinicians a black box that spits out answers isn’t helpful. Clinicians need “explainability,” a visual picture of how and why the AI-enabled tool reached its prediction, as well as evidence that the AI solution is effective. AI surveillance solutions are intended to support clinical decision making, not serve as a replacement. 

2. Expand data access

Volume and variety of data are central to AI’s predictive power. The ability to optimize emerging tools depends on comprehensive data access throughout the healthcare ecosystem, no small task as large amounts of essential data remain siloed, unstructured, and proprietary. 

3. Foster focused collaboration

Clinicians and data scientists must collaborate in developing AI tools. In isolation, data scientists don’t have the context for interpreting variables they should be considering or excluding in a solution. Conversely, doctors working alone may bias AI by telling it what patterns to look for. The whole point of AI is how great it is at finding patterns we may not even consider. While subject matter expertise should not bias algorithms,

it is critical in structuring the inputs, evaluating the outputs, and effectively incorporating those outputs in clinical workflows. More open collaboration will enable clinicians to make better diagnostic and treatment decisions by leveraging AI’s ability to comb through millions of data points, find patterns, and surface critically relevant information. 

AI-enabled clinical surveillance has the potential to deliver next-generation decision-support tools that combine the powerful technology, the prevention focus of public health, and the diagnosis and treatment expertise of clinicians. Surveillance is poised to assume a major role in attaining the quality and cost outcomes our industry has long sought.


John Langton is director of applied data science at Wolters Kluwer, Health, where artificial intelligence is being used to fundamentally change approaches to healthcare. @wkhealth


The Future of the ICU? How Clinical Decision Support Is Advancing Care

The Future of the ICU? How Clinical Decision Support Is Advancing Care
Kelly Patrick, Principal Analyst at Signify Research

Without a doubt 2020 has been a devastating year for many; the impact of COVID-19 on both personal lives and businesses has had long-term consequences. At the end of September, the number of COVID-19 cases fell just short of 350 million, with just over 1 million deaths reported. The expectation of a second peak in many countries exposed to the deadly illness is being handled with care, with many governments attempting to minimize the impact of an extreme rise in cases.  

COVID-19 the aftermath will be the new normal?

Despite the chaotic attempts to dampen the impact of a second peak, it is inevitable that healthcare facilities will be stretched once again. However, there are key learnings to be had from the first few months of the pandemic, with several healthcare providers opting to be armed with as much information to tackle the likely imminent surge of patients with COVID-19 head-on. The interest in solutions that offer support to clinicians through data analysis is starting to emerge with several COVID-19 specific Artificial Intelligence (AI) algorithms filtering through the medical imaging space. 

Stepping into the ICU, the use of analytics and AI-based clinical applications is drawing more attention. Solutions that collect relevant patient information, dissect the information, and offer clinical decision support are paving the way to a more informed clinical environment. Already, early-warning scoring, sepsis detection, and predictive analytics were becoming a focus. The recent COVID-19 outbreak has also driven further interest in COVID-19 specific applications, and tele-ICU solutions, that offer an alternative way to ensure high-risk patients are monitored appropriately in the ICU. 

What does the future hold?

Signify Research is currently in the process of assessing the uptake of clinical decision support and AI-based applications in the high acuity and perinatal care settings. An initial assessment has highlighted various solutions that help improve not only the efficiency of care but also improve its quality. Some of the core areas of focus include:

Clinical Decision Support & Predictive Analytics

Due to the abundance of patient data and information required to be regularly assessed and monitored, the high-acuity and perinatal care settings benefit from solutions offering clinical decision support. 

The ICU specifically has been a focus of many AI solution providers, with real-time analysis and support of data to provide actionable clinical decision support in time-critical situations. Clinical decision support solutions can collate data and identify missing pieces of information to provide a complete picture of the patient’s status and to support the treatment pathway. Some of the key vendors pathing the way for AI in clinical decision support in the ICU include AiiNTENSE; Ambient Clinical Analytics; Etiometry; BetterCare; AlertWatch; and Vigilanz Corp.

Early-warning

Early-warning protocols are commonly used in hospitals to flag patient deterioration. However, in many hospitals this is often a manual process, utilizing color coding of patient status on a whiteboard in the nurse’s station. Interest in automated early-warning systems that flag patient deterioration using vital signs information is increasing with the mounting pressure on stretched hospital staff.

Examples of early-warning software solutions include the Philips IntelliVue Guardian Solution and the Capsule Early Warning Scoring System (EWSS). Perigen’s PeriWatch Vigilance is the only AI-based early-warning scoring system that is developed to enhance clinical efficiency, timely intervention, and standardization of perinatal care.

The need for solutions that support resource-restricted hospitals has been further exacerbated during the COVID-19 pandemic. Many existing early-warning vendors have updated their surveillance systems to enable more specific capabilities for COVID-19 patients, specifically for ventilated patients. Companies such as Vigilanz Corp’s COVID Quick Start and Capsule Tech’s Clinical Surveillance module for ventilated patients enables healthcare professionals to respond to COVID-19 and other viral respiratory illnesses with customizable rules, reports, and real-time alerts.

Sepsis Detection

Sepsis is the primary cause of death from infection, accounting for 20% of global deaths worldwide. Sepsis frequently occurs from infections acquired in health care settings, which are one of the most frequent adverse events during care delivery and affect hundreds of millions of patients worldwide every year. As death from Sepsis can be prevented, there is a significant focus around monitoring at-risk patients.

Several health systems employ their own early-warning scoring protocol utilizing in-house AI models to help to target sepsis. HCA Healthcare, an American for-profit operator of health care facilities, claims that its own Sepsis AI algorithm (SPOT) can detect sepsis 18-hours before even the best clinician. Commercial AI developers are also focusing their efforts to provide supporting solutions.

The Sepsis DART™ solution from Ambient Clinical Analytics uses AI to automate early detection of potential sepsis conditions and provides smart notifications to improve critical timeliness of care and elimination of errors. Philips ProtocolWatch, installed on Philips IntelliVue bedside patient monitors, simplifies the implementation of evidence-based sepsis care protocols to enable surveillance of post-ICU patients. 

Tele-ICU

The influx of patients into the ICU during the early part of 2020 because of COVID-19 placed not only great strain on the number of ICU beds but also the number of healthcare physicians to support them. Due to the nature of the illness, the number of patients that were monitored through tele-ICU technology increased, although the complex nature of implementing a new tele-ICU solution has meant the increase has not been as pronounced as that of telehealth in primary care settings.

However, its use has enabled physicians to visit and monitor ICU patients virtually, decreasing the frequency and need for them to physically enter an isolation room. As the provision of healthcare is reviewed following the pandemic, it is likely that tele-ICU models will increase in popularity, to protect both the patient and the hospital staff providing direct patient care. Philips provides one of the largest national programs across the US with its eICU program.

Most recently, GE Healthcare has worked with Decisio Health to incorporate its DECISIOInsight® into GE Healthcare’s Mural virtual care solution, to prioritize and optimize ventilator case management. Other vendors active within the tele-ICU space include Ambient Clinical Analytics, Capsule Health, CLEW Med, and iMDsoft.

Figure 1 Signify Research projects the global tele-ICU market to reach just under $1 billion by 2024.

Interoperable Solutions

More and more solutions are targeted toward improving the quality of patient care and reducing the cost of care provision. With this, the requirement for devices and software to be interoperable is becoming more apparent. Vendors are looking to work collaboratively to find solutions to common problems within the hospital. HIMMS 2020 showcased several collaborations between core vendors within the high acuity market. Of note, two separate groups demonstrated their capabilities to work together to manage and distribute alarms within a critical care environment, resulting in a quieter experience to aid patient recovery. These included:

– Trauma Recovery in the Quiet ICU – Ascom, B Braun, Epic, Getinge, GuardRFID, Philips

– The Quiet Hospital – Draeger, Epic, ICU Medical, Smiths Medical, Spok​


About Kelly Patrick, Principal Analyst at Signify Research

The Future of the ICU? How Clinical Decision Support Is Advancing Care
Kelly Patrick, Principal Analyst at Signify Research

Kelly Patrick is the Principal Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. She joined Signify Research in 2020 and brings with her 12 years’ experience covering a range of healthcare technology research at IHS Markit/Omdia. Kelly’s core focus has been on the clinical care space, including patient monitoring, respiratory care and infusion.


Sepsis Awareness Month: Why Sepsis Awareness Is More Important Than Ever

Denise Cardo, MD Director, Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention In these unprecedented times, Sepsis Awareness Month is a moment for us to reflect on and recommit to focusing on the needs of the patient. Sepsis is the body’s extreme response to an infection, and without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death. During this challenging time we are facing because of the COVID-19 pandemic, it is important to reflect on the connections with sepsis. It is known that

Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients

<div class="right-align">
<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog-Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-how-ltac-hospitals-help-post-covid-patients.pdf?sfvrsn=dbab89ea_2" title="Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients" target="_blank">Download this article as a PDF</a></div>
<br />
<p>The latest research findings are honing in on the clinical conditions associated with COVID-19, along with the specific care pathways needed for patients, once stabilized, to fully recover. Specialized care after the initial hospital stay is proving to play a critical role.&nbsp;</p>
<p>Hospitalized COVID-19 patients often experience significant pulmonary complications, including severe pneumonia and acute respiratory distress-like syndrome. Further, many physicians are reporting that patients are developing post-intensive care syndrome (PICS) due to an intensive care unit (ICU) stay measured in weeks rather than days. The virus is also resulting in strokes, and causing sepsis, which can lead to multi-system failure and leave a patient with lasting damage to the lungs and other organs.</p>
<p><strong>This brief details COVID-19 patient care management strategies and research on how the clinical expertise of LTAC hospitals is uniquely suited for post-COVID patients.</strong></p>
<h2><strong>New Research on Care Solutions for Post-COVID Patients: The Role of LTACHs</strong></h2>
<p>A growing body of evidence indicates that the specialized services delivered in long-term acute care hospitals play a unique and positive role in treating patients recovering from COVID-19.</p>
<p>A recent study in the <em>Journal of Rehabilitative Management</em> stated that: &ldquo;Early rehabilitation of the COVID-19 patients can enhance pulmonary, respiratory function, reduce complications, improve function, cognitive impairments and quality of life."<sup>1</sup></p>
<p>Hospitalized COVID-19 patients are receiving life-saving care in an ICU for much longer than the average stay of three to four days and are often reliant on a ventilator, both of which puts them at high risk of developing post-intensive care syndrome (PICS) &ndash; a condition that can include ICU-acquired weakness, cognitive or brain dysfunction and other mental health disorders. Specialized care interventions and rehabilitation are needed to address the short- and medium-term consequences of post-COVID patients experiencing PICS symptoms and recovering from extended mechanical ventilation.<sup>2</sup></p>
<p>Additionally, as published recently in <em>The Boston Globe<sup>3</sup></em>:</p>
<p style="padding: 0 50px;">Many recovering COVID-19 patients need to be weaned off of ventilators and slowly reintroduced to eating on their own. Some also require speech therapy, pulmonary therapy, and dialysis.</p>
<p style="padding: 0 50px;">&hellip;COVID-19 has reminded the world of the importance of facilities that occupy the middle ground of the critical care landscape.</p>
<p style="padding: 0 50px;">&ldquo;In a pandemic, you really do need that kind of intensive care,&rdquo; said Grabowski, who co-authored a paper advocating for the importance of long-term acute care hospitals. "For years, we said, &lsquo;Why do we need long-term care hospitals?&rsquo; And all of a sudden with COVID, we&rsquo;re saying &lsquo;Why don&rsquo;t we have more long-term care hospitals?&rsquo;&rdquo;</p>
<p>Lastly, a recently co-authored a post in <em>Health Affairs</em> highlighted the critical resource that LTAC hospitals can play during the COVID pandemic.<a href="#_ftn4" name="_ftnref4"></a><sup>4</sup> Specifically, the researchers suggest that <strong>the clinical expertise in LTAC hospitals with &ldquo;critical care nurses, respiratory therapists, and intensivists&rdquo; aligns with the ongoing needs of COVID patients. </strong>The experts conclude that, &ldquo;During this unprecedented international crisis, [LTAC hospitals] offer additional opportunities to prepare for and manage the surge of COVID-19 patients experiencing respiratory failure.&rdquo;</p>
<h2><strong>Unique Clinical Presentations Require Specialized Care</strong></h2>
<p>Due to the complex medical needs of post-COVID patients, long-term acute care (LTAC) hospitals are a key care setting. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which have been symptoms of post-COVID recovery.</p>
<p>These specialty hospitals are unlike other post-acute care settings because they are licensed as a general acute care hospital by the state and certified by the Centers for Medicare &amp; Medicaid Services (CMS) as an LTAC hospital, and accredited by the Joint Commission under acute care standards. Additionally, care is provided in an interdisciplinary fashion, featuring daily physician visits and specialty physicians based on patient needs. Clinicians are specially trained for the critical care setting and are able to support prolonged recovery times.</p>
<h2><strong>LTACH Expertise in Pulmonary Care and Recovery</strong></h2>
<p>A patient&rsquo;s recovery and long-term lung health is directly dependent on the type and intensity of the care they receive. Distinct from all other post-acute settings, LTAC hospital clinicians are highly specialized in their ability to successfully liberate the most challenging ventilator patients, and LTAC hospitals feature hospital-level infection control, negative pressure rooms where needed and on-site laboratories and dialysis.</p>
<h2><strong>How Kindred Hospitals Can Help</strong></h2>
<p>We specialize in the treatment and rehabilitation of the post-intensive care and complex medical patient requiring continued intensive care, including specialized rehabilitation, in an acute hospital setting.</p>
<p>Our team of skilled and caring clinicians in our long-term acute care hospitals can be the right partner for you for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways.</p>
<p>Many of our hospitals have or are in the process of achieving disease-specific certification from The Joint Commission in key conditions such as respiratory failure and sepsis.</p>
<p>We also have decades of experience treating post-intensive care syndrome (PICS). Under Kindred&rsquo;s expert interdisciplinary care, patients receive targeted services including:</p>
<ul>
<li>Daily physician oversight</li>
<li>Physician specialists</li>
<li>ICU-level care and staffing when necessary</li>
<li>24/7 respiratory therapy coverage</li>
<li>IV pain control management and narcotic/opioid weaning</li>
<li>Early mobilization of both ventilated and spontaneously breathing patients</li>
<li>Antimicrobial management to complete sepsis treatment and prevent antibiotic resistance</li>
<li>Interdisciplinary teams to clarify interventions and monitor progress</li>
<li>A patient-centered, goal-directed care plan addressing function, cognition and medical impairments</li>
<li>Family-focused discharge planning, whether directly to home or to less intense levels of post-acute care</li>
</ul>
<p><strong>If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine the most appropriate care setting for your patient&rsquo;s next stage of treatment. If you are unsure of who your Kindred representative is, please feel free to <a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals" target="_blank">contact us</a>&nbsp;and speak with a Registered Nurse who can assist.</strong></p>
<hr />
<p>References</p>
<ol>
<li><span style="font-size: 12px;">Fary Khan, MBBS, MD, FAFRM (RACP), Bhasker Amatya, DMedSci, MD, MPH, <em>&ldquo;Medical Rehabilitation in Pandemics: Towards a New Perspective,&rdquo;</em> Journal of Rehabilitative Management, Vol. 52, Issue 4, April 9, 2020</span></li>
<li id="ftn2">
<p><span style="font-size: 12px;">Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020;52(4):jrm00044. Published 2020 Apr 15. doi:10.2340/16501977-2677</span></p>
</li>
<li id="ftn3">
<p><span style="font-size: 12px;">Dasia Moore, "COVID-19 patients are recovering, but with nowhere to go," The Boston Globe, May 19, 2020</span></p>
</li>
<li><span style="font-size: 12px;"><em>&ldquo;How Can We Ramp Up Hospital Capacity To Handle The Surge Of COVID-19 Patients? Long-Term Acute Care Hospitals Can Play A Critical Role,&rdquo;</em> Health Affairs blog, April 13, 2020, DOI: 10.1377/hblog20200410.606195</span></li>
</ol>
<a href="#" class="marketo-modal modal-popup" data-marketotitle="Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more" data-marketoformid="1536" data-marketosuccessmessage="Thank you for your submission." data-marketomodalbackground="modal-kindredblue-theme" data-marketomodallayout="marketo-modal-form" data-popupoptions="AutoLoadForNewUsers">Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more</a>

Treating Sepsis in a World of Value-Based Care

<div class="right-align">
<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog-Treating Sepsis in a World of Value-Based Care" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-treating-sepsis-in-a-world-of-value-based-care.pdf?sfvrsn=a3518cea_4" title="Treating Sepsis in a World of Value-Based Care" target="_blank">Download this article as a PDF</a></div>
<br />
<p>A recent study indicates that <strong>the incidence of sepsis among hospitalized patients is increasing by 8.7%</strong> per year.<sup>1 </sup>Due to the severity of the condition, these patients are at a high risk of returning to an acute care setting to receive the appropriate clinical treatment.</p>
<p>To improve patient outcomes and decrease the possibility of costly readmissions for this at-risk population, providers should not only continue to enhance their internal clinical capabilities but also team with post-acute partners with expertise in treating sepsis.</p>
<p><strong>In this whitepaper, we outline the latest statistics and resources regarding sepsis and the post-acute strategies providers should consider to enhance outcomes for this critical population.</strong></p>
<div class="center-align"><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-sepsis-infographic.jpg?sfvrsn=9d6a8cea_0" data-displaymode="Original" alt="The incidence of sepsis among hospitalized patients is increasing by 8.7% per year" title="The incidence of sepsis among hospitalized patients is increasing by 8.7% per year" /></div>
<h2><strong>The Sepsis Crisis</strong></h2>
<p>Sepsis is a major problem. Here is what we know:</p>
<ul>
<li>Between 750,000 and 1.7 million Americans develop sepsis each year.<sup>2,3</sup> </li>
<li> The sepsis mortality rate is between 25-35%, meaning more than 270,000 people die from sepsis each year.<sup>3</sup></li>
<li>Sepsis accounts for more than 50% of hospital deaths.<sup>1</sup></li>
<li> Mortality increases dramatically with greater disease severity: 10&ndash;20% for sepsis, 20&ndash;40% for severe sepsis, and 40&ndash;80% for septic shock.<sup>1</sup></li>
<li> In a global study, sepsis was identified during the ICU stay in 29.5% patients, including 18.0% who exhibited sepsis at ICU admission.<sup>4</sup></li>
<li> Sepsis is very expensive to treat, with an annual price tag of approximately $17 billion.<sup>2</sup></li>
<li> Sepsis readmissions cost the U.S. more than $3.5 billion per year, or an average of $16,852 per readmission, according to a study published in March 2019 in Chest Journal. For reference, the annual readmission cost for the four conditions Medicare&rsquo;s Hospital Readmissions Reduction Program aims to reduce &mdash; acute myocardial infarction, congestive heart failure, COPD and pneumonia &mdash; is $7 billion combined.<sup>5</sup></li>
</ul>
<img class="float-right" src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-sepsis-info2.jpg?sfvrsn=ef6a8cea_0" data-displaymode="Original" alt="Sepsis readmissions cost the U.S. more than $3.5 billion per year, or an average of $16,852 per readmission" title="Sepsis readmissions cost the U.S. more than $3.5 billion per year, or an average of $16,852 per readmission" />
<p>Innovative treatments and care strategies are required to combat the growing impact of sepsis, especially in light of healthcare&rsquo;s continued push toward value-based care, which puts heightened pressure on managing total care costs and readmission rates.</p>
<p>To that end, this focus on reducing readmissions and total cost of care highlights the need for those in charge of discharge and placement after a hospital stay to accurately determine the most clinically appropriate post-acute setting for each unique patient. </p>
<p><strong style="color: #4183aa; font-size: 20px;">Resources and Case Studies to Help Improve Sepsis Outcomes</strong></p>
<p>To combat the growing rate of sepsis in hospitalized patients, providers should evaluate how this critical population is cared for. Fortunately, there are several existing resources providers can use as a base to build their own protocols:</p>
<ul>
<li><strong><a href="http://www.survivingsepsis.org/SiteCollectionDocuments/Surviving-Sepsis-Campaign-Hour-1-Bundle-2018.pdf" target="_blank">The Surviving Sepsis Campaign Bundle: 2018 Update</a></strong><strong>:&nbsp;</strong>The Surviving Sepsis Campaign launched a new one-hour bundle for sepsis patient management that outlines the most critical steps to take within the first hour of sepsis identification.<sup>6</sup> </li>
<li><strong><a href="https://www.advisory.com/research/physician-executive-council/tools/2019/the-sepsis-cvr-starter-kit" target="_blank">The Sepsis CVR Starter Kit</a></strong><strong>:&nbsp;</strong>This kit can help providers build a successful sepsis care variation reduction (CVR) strategy, including tips on governance and care standard design resources.<sup>7</sup> </li>
<li><strong><a href="https://www.advisory.com/research/physician-executive-council/studies/2014/ten-imperatives-to-reduce-sepsis-mortality" target="_blank">Ten Imperatives to Reduce Sepsis Mortality</a>:&nbsp;</strong>Check out this online list from The Advisory Board for ways to build a system of care that promotes early identification, coordinates care team responsibilities and delivers timely treatment for every sepsis patient.<sup>8</sup></li>
<li><em> <strong></strong></em><strong>The <em>Journal of the American Medical Association</em> &ndash; findings on New York&rsquo;s &ldquo;Rory&rsquo;s Regulation&rdquo;:&nbsp;</strong><em><strong></strong></em>The recent findings of a multi-year study attributes a drop in sepsis mortality rates in the state of New York since the law was enacted to three practices:<sup>9</sup>
<ul>
<li>More patients receiving evidence-based sepsis care, including early antibiotics and resuscitation </li>
<li>Hospital staff across the state being educated on how to recognize and treat sepsis </li>
<li>Healthcare professionals statewide paying closer attention to sepsis
</li>
</ul>
</li>
</ul>
<p>By identifying areas for improvement, many hospitals have been able to improve their sepsis mortality rates through enhanced early identification and streamlined treatment processes.</p>
<h2><strong>The Clinical Benefits of LTAC Hospitals in Treating Sepsis: Reducing Readmissions</strong></h2>
<p>In addition to looking internally, providers should seek post-acute partners who are capable of identifying and treating at-risk sepsis patients in order to avoid costly hospital readmissions. Long-term acute care hospitals are the most clinically appropriate post-acute setting for treating sepsis because of the condition&rsquo;s severity and the hospital&rsquo;s capabilities.</p>
<p>Sepsis must be treated in a hospital setting and long-term acute care (LTAC) hospitals are well equipped to both identify and treat sepsis. Because LTAC hospitals have the same licensure and accreditation as acute care hospitals, they are clinically capable of treating septic patients, thereby avoiding readmission. In contrast, if a high acuity patient is discharged directly to a skilled nursing facility and then requires sepsis treatment, the patient would need to readmit to the hospital setting for care.</p>
<p>While LTAC hospitals provide care for a very high-acuity niche patient population, they play a vital role in achieving more efficient recovery of patients who have a high risk of readmission due to their clinical complexity. By transitioning these challenging patients to an LTAC hospital, when it is the most appropriate site of care for their needs, a significant portion of financial losses due to readmission penalties for short-term providers can be avoided.</p>
<h2><strong> <strong>Kindred&rsquo;s Sepsis Program: How Kindred Can Help Your Sepsis Patients</strong></strong></h2>
<p>Kindred Hospitals specialize in the post-intensive care treatment of patients with complex medical cases who require continued intensive care and specialized rehabilitation in an acute hospital setting. With daily physician-directed care, ICU- and CCU-level staffing ratios and ACLS-certified nurses, specially trained caregivers, we work to improve outcomes, reduce costly readmissions and help patients transition home or to a lower level of care. </p>
<p> We are committed to pursuing innovations in care delivery and payment models to provide new tools and solutions to our patients and their families as well as to our provider partners. Many of these resources and initiatives are designed to ensure efficient care management for each patient.</p>
<p>One such initiative is our effort to achieve disease-specific certification from The Joint Commission for sepsis in all Kindred Hospitals across the country. The certification recognizes healthcare organizations that provide clinical programs across the continuum of care for sepsis. It evaluates how organizations use clinical outcomes and performance measures to identify opportunities to improve care, as well as to educate and prepare patients and their caregivers for discharge.</p>
<p>We have proven success in treating patients with sepsis. We have already instituted the following sepsis protocol in all of our hospitals:</p>
<ul>
<li> A review of every new admission&rsquo;s chart to establish whether or not they qualify for our Sepsis Program.</li>
<li>An assessment and evaluation at least once every shift of all patients who qualify for our Sepsis Program.</li>
<li>A robust Sepsis Protocol includes STAT interventions for any patient who screens positive, including blood lactate level and blood cultures run prior to administration of antibiotics.</li>
<li>An individualized plan of care and creation of interdisciplinary goals for the patient.</li>
<li>Treatments and therapies based on evaluation of the patient in relation to our assessment of their health.</li>
<li>Extra care and education for the patients and their families while they are enrolled in the Sepsis Program.</li>
</ul>
<p>We are committed to continued clinical growth and furthering our expertise in areas of care this population will demand. </p>
<p><strong> <strong>To learn more about how Kindred Hospitals can help you achieve enhanced outcomes for your critically ill patients,&nbsp;</strong><a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals/make-a-referral">Contact Us</a>.</strong></p>
<hr />
<p>References:</p>
<ol>
<li><span style="font-size: 12px;">Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. <em>Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level.</em> Crit Care Med. 2018;46(12):1889&ndash;1897. doi:10.1097/CCM.0000000000003342</span></li>
<li><span style="font-size: 12px;"> https://www.centerfortransforminghealthcare.org/improvement-topics </span></li>
<li><span style="font-size: 12px;">https://www.cdc.gov/sepsis/datareports/index.html </span></li>
<li><span style="font-size: 12px;">Sakr Y, Jaschinski U, Wittebole X, et al. <em>Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit.</em> Open Forum Infect Dis. 2018;5(12):ofy313. Published 2018 Nov 19. doi:10.1093/ofd/ofy313
</span></li>
<li><span style="font-size: 12px;"><em>Epidemiology and Predictors of 30-Day Readmission in Patients With Sepsis</em> Gadre, Shruti K. et al. CHEST, Volume 155, Issue 3, 483 &ndash; 490 </span></li>
<li><span style="font-size: 12px;">http://www.survivingsepsis.org/SiteCollectionDocuments/Surviving-Sepsis-Campaign-Hour-1-Bundle-2018.pdf
</span></li>
<li><span style="font-size: 12px;"> https://www.advisory.com/research/physician-executive-council/tools/2019/the-sepsis-cvr-starter-kit </span></li>
<li><span style="font-size: 12px;">https://www.advisory.com/research/physician-executive-council/studies/2014/ten-imperatives-to-reduce-sepsis-mortality </span></li>
<li><span style="font-size: 12px;">https://www.healthleadersmedia.com/clinical-care/new-yorkssepsis-protocols-lower-death-rates</span>
</li>
</ol>
<a href="#" class="marketo-modal modal-popup" data-marketotitle="Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more" data-marketoformid="1536" data-marketosuccessmessage="Thank you for your submission." data-marketomodalbackground="modal-kindredblue-theme" data-marketomodallayout="marketo-modal-form" data-popupoptions="AutoLoadForNewUsers">Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more</a>