Kathleen Merkley, DNP, APRN, FNP

据估计，COVID-19患者的住院死亡率在15%至25%之间，因此必须尽早识别高风险个体。临床医生需要可靠的工具来识别严重恶化风险最高的个体。风险评分工具适用于常见的急性情况(如感染性疾病、低血容量或心源性休克)，但这些方法并不关注COVID-19的主要临床影响呼吸功能。因此，出现COVID-19严重症状的患者可能会根据心率和血压等生命体征表现稳定，但实际上他们处于危重状态。一种更先进的COVID-19风险评分方法侧重于低氧血症，或低于正常血氧水平。

The CDC reports that one in three inpatient deaths is related to sepsis, with related health system costs totaling over $1.5 billion. Fortunately, nearly all sepsis deaths are preventable. However, most health systems lack the tools and information they need to steer sepsis improvement efforts that significantly reduce mortality rates.

Robust data infrastructure supports sepsis improvement teams by surfacing detailed data that reveals care gaps and missed opportunities. With access to sepsis data, improvement teams can implement five data-informed strategies that reduce sepsis deaths:

1. Create alerts for early detection.
2. Improve three-hour bundle compliance.
3. Optimize emergency department processes.
4. Leverage the CDC Sepsis Surveillance Toolkit.
5. Implement care transition processes to prevent sepsis readmission.

How can health systems avoid just talking about improvement and instead achieve real progress in clinical quality performance? First, improvement teams need access to a robust data infrastructure that can provide a complete picture of performance. This analytic insight reveals process gaps and opportunity areas where the care team can target improvement efforts.

After selecting an opportunity area, care teams are ready to follow the three-step process to achieve meaningful clinical improvement:

1. The “why”: Identify the outcome goal.
2. The “what”: Select a written, measurable, and time-sensitive process metric to evaluate the process.
3. The “how”: Identify the best interventions that will support the desired change in a process.

The traditional sepsis identification method—based on a combination of physician notes, coding, and billing—is often varied and too subjective, leading to inaccurate data. Because margins are tight and health systems can’t afford to waste any resources, clinical teams need to start with the most effective sepsis identification method. Using physiological data, such as vital signs, to identify sepsis is proving to be highly effective.

通过生理数据方法，医疗提供者依靠身体的反应——而不是受偏见、轶事信息或报销率的影响——来更准确地识别败血症患者。有了更有效的败血症识别方法，提供者可以更快地实施干预措施，从而获得更好的结果。

Improving patient satisfaction scores and the overall patient experience of care is a top priority for health systems. It’s a key quality domain in the CMS Hospital Value-Based Purchasing (VBP) Program (25 percent) and it’s an integral part of the IHI Triple Aim.

But, despite the fact that health systems realize the importance of improving the patient experience of care, they often use patient satisfaction as a driver for outcomes. This article challenges this notion, instead recommending that they use patient satisfaction as a balance measure; one of five key recommendations for improving the patient experience:

1. Use patient satisfaction as a balance measure—not a driver for outcomes.
2. Evaluate entire care teams—not individual providers.
3. Use healthcare analytics to understand and act on data.
4. Leverage innovative technology.
5. Improve employee engagement.

This article also explains why patient experience is so closely tied to quality of care, and why it’s a prime indicator of a healthcare organization’s overall health.