SCCM Resource Library-Asmund S. Laerdal Lecture Award Winner Presentation

Video Transcription

Good afternoon. It is my pleasure to introduce this year's Asimov-Lehrer Lecture being presented by Dr. Krista Schorr.  Dr. Schorr is an Associate Professor of Medicine and Clinical Nurse Scientist at Cooper Medical  School of Rowan University and Clinical Nurse Scientist for Cooper University Hospital in Camden, New Jersey. She's a long-time contributor to the Society of Critical Care Medicine.  Dr. Schorr is one of the three-person team that developed, field-tested, and finalized the content of the Surviving Sepsis Campaign performance improvement software, and that  have been used by more than 200 sites worldwide.  Dr. Schorr has participated in resuscitation-related investigations, including performance improvement  in the critical first six hours of severe sepsis and outcomes of trauma victims with cardiac arrest who survived to intensive care unit admission.  She is also a member of the Emergency Medicine Shock Research Network investigators. They led the multicenter study of early lactic clearance as a determinant of survival in  patients with presumed sepsis. She has authored and co-authored over 180 peer-reviewed articles, invited book chapters, abstracts, and has lectured extensively around the world.  Today, Dr. Schorr will present the lecture, Avoid Running on Empty, Applying a Focused  Approach to Resuscitation, and will be available for live question-and-answer session immediately following this presentation.  Ladies and gentlemen, please welcome Dr. Krista Schorr. Hi, good afternoon. My name is Krista Schorr, and I'd really like to thank the Congress Co-Chairs and Program  Committee and the Laerdal family and company for selecting me for the 2021 Asmund S. Laerdal Memorial Lecture Award. It is my honor to speak to you today.  My title is Avoiding Running on Empty and Applying a Focused Approach to Resuscitation. So as far as disclosures, I have no financial disclosures, however, I am a member of the  Surviving Sepsis Campaign Steering Committee as well as the Group Head for Long-Term Outcomes and Goals of Care for the 2020 Surviving Sepsis Campaign Guidelines.  When I was approached about this award, I was extremely excited, but I also wanted to learn a little bit more about the founders of this particular company.  So it was established as a children's book company and toy company in 1940, and Laerdal's work of working with soft plastics really later produced what we know today as, in the  And together with Dr. Laerdal, Dr. Jorn Lind, and Dr. Peter Stafford developed the world's first patient simulator, Resuscit-Ani, that was introduced in 1960.  So again, our world has certainly changed with this technology and how we learn how to use CPR, and we're very appreciative of the work that has been done by Laerdal and  the company, obviously, has changed a bit over the years.  When I reviewed the website, I learned a little bit more.  I also learned that their mission and vision really resonated with me. As I viewed the foundation website, I was struck by the vision.  No one should die or be disabled unnecessarily during birth or from a sudden illness, trauma, or medical nerve.  This resonated with me as most of my nursing career was really built on prevention.  How can we prevent complications or progression from illness? As I move through this talk, I hope this vision statement is able to provide an image for you  on how we can all do better in helping save lives and improving patient care.  So the goals for my talk today are three.  The first is to have a little bit of a discussion on reducing in-hospital patient decompensation, talk a little bit about early sepsis recognition and resuscitation,  and then finish up with the value of a multidisciplinary approach to resuscitation. So we think about running on empty, avoid running on empty.  We've all experienced this, I'm sure, in our lives in one way or another, whether we ran out of gas.  Again, there's signs that we're going to be running low on gas,  if you're like me, I was taught by my parents and my grandparents that you should never let the gas tank blow one quarter of the time.  But we're also faced with other issues in our lives where we get notification that our battery on our cell phones is running low.  So how many of us see the red and we're at 10% and we're looking for chargers? How can we get charged? We can't really function without our cell phones.  Or we run out of energy even during exercise. So again, we've all experienced this in our lives.  But what about our patients in our healthcare system? How can we help them avoid running on empty and improve how we care for them and decreasing  those that have adverse events or actually experience decompensation?  So when we think about decompensation, in medicine, decompensation is really the functional deterioration of a structure or a system that has previously worked,  but unfortunately is not working currently. The body is no longer compensated, or whatever the system is no longer compensated.  So there's a lot of ways to decompensate, but we're really going to focus our attention on patient decompensation for the next 40 minutes or so.  So most of us, when we think about decompensation, we think about in-hospital cardiac arrest. And the realities of that are approximately 290,000, 292,000 in-hospital arrests occur  annually in the U.S. And survival is quite low, with less than 20% survival. And about 50% of those actually occur on the wards, which is the medical surgeon with  shutdown units, which really encompass a large part of our institutions. And part of that may be related to the clinician-to-patient ratio on these units is low.  So it's not only the clinicians, but the nurse-patient ratio varies as well. So it could be the nurse be 1 to 4 patients, or 1 to 8, or 1 to 9, depending on what sector  or what type of institution you're in. And often, these episodes are preceded by clinical signs of deterioration, which you'll see there's a pattern with that.  So looking at survival after in-hospital cardiac arrest, this is data based on the Get With The Guidelines resuscitation registry on adult in-hospital cardiac arrest from  2000 to 2017. And the dotted lines represent the 95% confidence intervals. And as you can see, there's broken down into non-trackable rhythms, all rhythms, and trackable rhythms.  And again, there has been some progress in survival.  But again, it's not significantly changed.  And what we're finding is that there's increased awareness in-hospital cardiac arrest. But we also have to increase our awareness that we need to optimize clinical care.  And new research in this area may be helpful in improving patient outcomes. And from this paper, I really was struck by this particular topic.  And it really sets the tone for what's going to happen over the next period of time that we're together here.  So efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate intervention for response, such as rapid  response teams. So it's not only that can we identify them, but then what are we going to do after? And this is not something new, right?  We've been dealing with this for a long time. And this is a paper that I found that I thought was fascinating.  It's more than 30 years ago, looking at medical patients at high risk for catastrophic deterioration.  And Dr. Sachs and Dr. Charleston worked together on this paper, looking at signs and symptoms, patient comorbidities.  Again, much of what we're doing now, they didn't even have the resources that we have as far as computers and electronic medical records to filter through.  But what they found was the most important predictor of an arrest was the patient's clinical course in the hospital. So did they have any adverse events? Were they progressing well?  Did they decline? And they also found that in most patients, there was a degree of advanced warning.  Patients that were high risk for deterioration, very few of them actually had arrests that occurred prior to a new complication. So oftentimes it was a new complication.  And most commonly, the signs of a predictor of an arrest was acute dyspnea, which we'll see is common as we go through the different warning systems that others have built.  So how can we identify deteriorating patients? Some of us are looking at machine learning, artificial intelligence, creating algorithms,  whether they're open algorithms or a black box algorithm, and putting patients in categories such as low risk or high risk.  But maybe it's actually a combination as we move forward that we're going to need pieces of the puzzle that are going to have to go together, meaning that we need machine learning,  AI clinician input.  We need rapid response teams to respond to these groups. But there's a lot of mechanisms that I think we're going to have to put in place in order  to actually improve patient outcomes and identify patients early and act on it early.  One such design here is this. This is a schematic that actually is looking at preventing cardiac arrest with mobile monitoring solutions.  So this is looking at a sensor that could be placed on the neck, wrist, or finger, looking  at physiologic parameters for the early detection of respiratory events, cardiac arrest, post-op, bleeding, and sepsis.  And this information is sent to a central station and filtered and develops early warnings,  also can display data.  And again, this can be used to automate an early warning system to a mobile device. It also can be used multi-purposely, as it's shown here, using it for point-of-care  echocardiography.  There are several studies that have been done looking at machine learning and methodology related to machine learning.  This particular study actually compared machine learning methodology to conventional methods  in regression for predicting clinical deterioration on the floor. So it's a large multi-center database with five centers.  There's about 270,000 admissions, 16,000 adverse events, 424 cardiac arrests, and 2,840 deaths on the ward.  And a little over 13,000 ICU transfers occurred during this study period. So again, they're looking at medical surgical patients and the primary outcomes were cardiac  arrests, transfer to the floor, transfer to the ICU, and death on the wards without a temporary cessation.  So I'm not really going to get into the machine learning methodology, because that's not my area.  But what I found interesting from this study was that they were able to identify variables that were important predictors of deterioration.  Again, respiratory rate is right there at the top. Heart rate, age, and stock blood pressure around at the top four, whereas number of  ICU phase, albumin, bilirubin, and protein were less, appeared to be less important.  So again, respiratory rate seemed to make a huge difference.  Again, has been using quite a few scores. So these are important predictors.  And others have used models as well. In this randomized controlled trial using real-time automated clinical deterioration  alerts, Dr. Koloff and colleagues at Orange Jewish Hospital in St. Louis.  Again, they had 571 patients in the study and eight medicine units. And they used real-time alerts.  The real-time validated algorithms that were sent to the rapid response team. That was the intervention group, or this information was hidden, which was the control group.  And the outcomes were transfer to ICU, hospital mortality, and length of stay.  And they also looked at diagnostic and therapeutic interventions that were initiated within 24 hours of generating this alert.  And they looked at, compared the intervention groups to control group. And there really wasn't a whole lot of difference between the two groups, except that  the patients in the intervention group were more likely to have their primary care team notified by a rapid response nurse regarding their medical condition.  They're more likely to be placed on telemetry and oximetry.  Whereas patients in the control group appeared to receive antibiotics more frequently, or in order for antibiotics, more frequently than the intervention group.  It's really not clear why this is the case as far as the antibiotics. But perhaps it may be just a reflex based on the patient's clinical condition at that  particular time, not having all the information that others may have had in the intervention group.  But again, this is just hypothetical, and it's really not clear.  But again, this is important information, and it doesn't appear that there's really a whole lot of difference between the two groups.  As far as outcomes, again, the intervention group and control group in this particular study of 571 patients is very similar.  The only difference was hospital length of stay was a bit shorter in the intervention group.  More recently, there's been a publication in November of 2020 by Dr. Escar and colleagues  in California, looking at automated identification of adults at risk for in-hospital clinical deterioration.  Again, they used a validated model capture from information in the electronic medical record to identify patients that were high risk for deterioration, and they created an  automated real-time risk score calculation.  The intervention part of the program was that they had nurses remotely monitoring these patients and these scores.  Once patients were identified, the nurses were able to review their records, and they were able to communicate with the rapid response team.  The intervention was they had a real-time risk score.  The nurses were monitoring this remotely, and they communicated this with the rapid response team.  There was an intervention cohort and a control cohort, and it was deployed in 19 hospitals, and the primary outcome was mortality within 30 days after the alert.  This is just a breakdown of the patient population. As you can see here, there was 548,000-plus patients admitted to the ward or sat-down  unit, and they were further classified as those that met the alert threshold, where nearly 44,000 patients were in the target population, meaning they did meet the alert threshold.  Then they were further divided into two groups, those that received the advanced alert monitoring program, meaning the nurse and the notification and the rapid response team.  There were 15,000, a little over 15,000 in that group, and the comparison group, there were almost 28,462 that were in the comparison group.  Some of the validated models that they used were the COPS-2, which is a comorbidity point score, and the LABS-2, which is a laboratory-based acute physiology score, as well as the  Charleston Comorbidity Index. We look here, and this is a staggered deployment of the advanced alert monitor program.  The left column shows the deployment sequence of each hospital, and the next column shows the number of hospitalizations in which the patient reached the alert threshold.  Then in parentheses, you'll see the mortality.  If you look at the first hospital that was deployed, they had a run-in period that actually started in August of 2015, and then the program was deployed in August 2016.  You can see that there are more patients in the after program versus the before program,  whereas the last site that was deployed, site number 19, they actually had more in the before program versus those that were in the after program.  Some of the outcomes from the study, they did have a report of some unadjusted analysis comparing the intervention cohort to the comparison cohort, and compared to the cohort  without the advanced active monitor program, the intervention group, which did have the advanced alert program monitor, meaning the nurse and the call to the rapid response team,  that group actually had a lower incidence of ICU admissions. They also had shorter length of stay among survivors, and the mortality was lower within  30 days after reaching an alert threshold.  Again, this was a larger study than the previous study, but there still is obviously some work that needs to be done to implement this program in other institutions, but it  is quite interesting as well. There have been some clinical assessment tools developed to identify patients early or identify patients who are at risk for decline.  One such score is acute SOFA score, the quick sequential organ failure score, with a score of two or more SOFA points near the onset of infection was associated with a greater  risk of death or prolonged intensive care unit stay. Again, this score really needs to be prospectively evaluated in ward patients.  The other one is the MUSE SRS protocol, which is a modified early warning system sepsis recognition score, and a score of greater than or equal to five was statistically linked  to increased likelihood of death or admission to an intensive care unit. There are a variety of automated alerts that we have in our medical record system, as well  as in other areas of the country as well. Hospitals have created some homegrown type of alerts for sepsis over the years as well.  Now we have alerts. There are people that are developing alerts and trying to identify patients who are going to deteriorate.  But once we identify those patients, we also need some sort of intervention, which is where the rapid response teams come in. So this is just a table from a publication in 2011.  It really compares the traditional co-team versus a rapid response team. And there is a difference in why we would call the team, conditions that are addressed,  the composition of the teams vary, the call rate, as well as in-hospital mortality. So we look at rapid response, often called for low blood  pressure, heart rate, respiratory changes, and altered consciousness. And the majority of the time the conditions are sepsis, pulmonary edema, arrhythmias, respiratory failure.  And again, the calls are more frequent, but the mortality in this patient population is considerably low. There have been many hospitals that have initiated  sepsis response teams in suspected or confirmed sepsis. And they've seen that there's been an improvement in intensivists at the bedside, administration of fluids  and antibiotics, and transfer to the ICU. So even the rapid response teams themselves have been broken out for sepsis patients.  And then there also have been reports of cardiac arrest teams, and where the patients could be potentially transferred to cath labs sooner and initiate targeted  hypothermia as indicated. So there are some sub-rapid response teams in various areas of the country and the world as well. So we're going to move on to the second section,  the importance of early sepsis recognition and resuscitation. And sepsis is the most common hospital diagnosis and the most costly.  And mortality from sepsis has decreased over the years, yet remains unexpectedly high. For many of you, you've been involved with sepsis care for a long time.  The first guidelines actually came out in 2004 and had iterations every four years, with the most current guidelines should be coming out shortly, the 2020 guidelines.  You can see that there has been a lot of work on the guidelines in the first release 2004. You know, it's a very small document with 15 pages, and the 2016 guidelines with 73 pages.  And a lot of it has to do with the references. There's been additional research findings that have occurred, which modifies the way we treat patients and informs  our recommendations and the guidelines. So as new literature evolves and research is presented, so do the guidelines. The initial guidelines, the 2004 guidelines were converted  into bundles. For most of you may not be familiar, but there was a six-hour bundle and a 24-hour bundle. And what we do now is primarily a three and a six-hour bundle,  and it was focused more on resuscitation. We changed the bundle format. The sepsis management bundle was dropped. And this also was converted into the database that was used  internationally. The first publication that came out of that database included 165 volunteer sites in the U.S., Europe, and South America.  This included 15,000 patients, and data captured in this particular study was looking at the six and 24-hour bundle. And the findings here, the conclusion was that the campaign,  the continuous quality improvement in sepsis care, saw that there was a reduction in hospital mortality rates associated with participation.  However, it really was just the impetus, the start of really our quality improvement efforts. And sites continue to collect information.  One thing that we found that was really interesting and maybe disheartening at the same time was that medical surgical support patients died disproportionately.  So looking at that study that included the 15,000 patients, you can see that hospital mortality was about 34% for all patients,  but there was certainly a difference for patients who presented to the emergency department with sepsis compared to those that presented to the ward with sepsis.  All these patients required an ICU stay. You can see the ward patients and mortality was almost 20% more than those patients that presented to the ED.  So this was really a concern and really started to have the leadership of not only the surviving sepsis campaign, but many ICUs across the world trying to figure out what we can do  to improve this outcome. So in 2012, there was a significant change in the guidelines where we really recognized that we need to improve. We're collecting data.  People are implementing the bundles for several years now, but there really needs to be something that needs to be done and change not only in those hospitals who are participating  in the improvement program, but hospitals all over the world. So one of the recommendations was that we recommend that there's a screening  program in place for sepsis and a performance improvement. So the recommendation with the 2012 guidelines was that we recommend  hospitals and hospital systems have a performance improvement program for sepsis, including sepsis screening for acutely ill, high-risk patients.  Again, this was something that was a recommendation, a best practice statement. There really wasn't a whole lot of evidence to say that this was something  that we should do, but we recognize that we can initiate treatment if we don't know that patients have sepsis and we're not capturing it early,  which really helped us recognize that we need to have, in order for us to get the patients the right treatment at the right time, we need to identify patients early.  Our early work really focused most of our attention in the emergency department and critical care because sepsis was thought of as an ICU issue,  and most of the patients, 60% of the patients at that time, presented to the emergency department with sepsis who were transferred to the ICU.  Again, we needed to look at what was different in the medical-surgical units and how can we facilitate performance improvement and quality  and better outcomes for those patients on the medical-surgical units. Again, the makeup, the way things function in the medical-surgical unit  is very different, but you'll see very soon how that was actually implemented. At the same time, changes were made to the sepsis bundles.  We moved from the 6- and 24-hour bundle to a 3- and 6-hour bundle, which most of you are familiar with, was what we're doing in most of our institutions today.  This 3- and 6-hour bundle was also incorporated into the U.S. Centers for Medicare and Medicaid Services as the SEP1 bundle for the management of sepsis and septic shock.  Most of us are in the process of capturing data and reporting that information to our regulatory agencies as well. Like I mentioned, we did have a database,  and sites continue to collect data on the 6- and 24-hour bundle. This publication that came out in 2014, again, reinforced the fact that  ward patients have a higher mortality than those patients in the emergency department. But in this particular paper, it really looked at those hospitals  that had low compliance versus high compliance with the resuscitation bundle. The resuscitation bundle was a lactate, drawing blood cultures,  administering antibiotics, administering fluids. Again, that was the crux of the resuscitation bundle. You can see that the mortality was higher in those that had a low compliance  versus those that had a high compliance. Again, our eyes continually went to the wards as to why their mortality was so much higher.  Really, what we decided as a group and the leadership of the Surviving Sepsis Campaign was that we needed to do something to make change on general medical-surgical floors.  The Surviving Sepsis Campaign initiated the Phase IV Collaborative. This was a paper that actually went through how you would actually implement  this multi-center performance improvement program for early detection and treatment of severe sepsis in general medical-surgical floors. This is the timeline of the Collaborative.  It started in January 2014 and ended in June of 2015. As you can see, there were several learning sessions that were in person  and quite a few webinars and conference calls to support those that participated in this study. There were 60 sites.  It was a collaboration between the Surviving Sepsis Campaign, Society of Hospital Medicine, Society of Critical Care Medicine, and the European Society of Intensive Care Medicine.  It was supported and funded by the Gordon and Betty Moore Foundation. As the collaboration moved forward, things started to improve.  The mantra for this study really was screen every patient every day, every shift. The teams actually recognized that nurses outside the emergency department  really could make a difference if they screen patients every day. The leadership really recognized that nurses are in a good place to be able to identify patients with sepsis.  There are several reasons why nurses should screen for sepsis, not only for early recognition and early intervention,  but also if we screen patients every day, even for patients that are diagnosed with sepsis, that it could actually identify patients that are progressing in their organ dysfunction  or help prevent worsening organ dysfunction, and then also evaluate whether or not the condition is improving, are the antibiotics working, and then plan for disposition.  Nurses really are going to play a key role in identifying patients and helping improve outcomes.  Nurses were very much valued in this program, as they are with most interventions within the institution. There were several alerts that were developed.  When you think about alerts, there could be an alert that tells you that sepsis is probably present versus other alerts that tell you to look for sepsis.  It depends on how the alerts are built. This was an alert that was built early on in our program. This is a system that was used in our hospital at Cooper.  It was in the general hospital medicine article that was built upon the surviving sepsis campaign screening tool.  Again, it's set up for the nurse to be able to communicate using a situation background and assessment and provide recommendations.  But we recognize that not only were things different on the medical surgical floor as far as resources and staffing,  the nursing staff communicated to us that they were not accustomed to communicating about sepsis with a provider like the nurses in the ED and the ICU were.  We really tried to help them and work to produce efficient and effective ways of communication with sepsis and the providers.  During our in-learning sessions, we actually had nurses and physicians communicate sepsis in this fashion.  We had them take it back to their institutions so the nurses could learn how to communicate effectively. There were a lot of barriers as to why the bundle indicators may not be met.  Some of it had to do with the late recognition and treatment, documentation issues, various communication failures, and their potential solutions.  Providing education and real-time feedback from the nurses, having routine screening tools, order sets,  nurse-driven protocols depending on your state, that seems to make a huge difference.  Then in some institutions, they were able to have a flexible nurse-to-patient staff ratios during that first six hours  for the patient to receive the appropriate treatment in a timely fashion.  The take-home message really from all this work is that our goal really is to decrease delay in sepsis treatment.  In this publication from Dr. Seymour and colleagues looking at the New York State database where they had a mandatory protocol implementation publication for 2017,  for every hour delay in antibiotics and other key steps increases the odds of death by 4%. Our goal really is to get the patients the treatment they need in a timely fashion,  which leads me into how the bundles have changed over time. We went from a 6- and 24-hour bundle to a 3- and 6-hour bundle, which is what most of us are doing.  In 2018, there was a publication that came out looking at the thriving sepsis campaign bundle. It was called the Hour One Bundle. The revised bundle was published in 2018.  The information was dispersed, and I shared the information with the nursing colleagues in this publication in 2018. The goal was to deliver quality, timely treatment.  The sepsis bundles were designed for bedside application guidelines to promote the importance of timely management.  The 2018 bundle was called the Hour One Bundle to focus attention on beginning resuscitation immediately.  Again, nurses were critical to improve outcomes for these patients with sepsis.  Over the next year, there was some controversy and some misunderstanding of the intent of the Hour One Bundle.  There was a revision that was released, and this is just the infographic that was released in 2019.  Basically, what the difference change here was that we need to recognize that sepsis is a medical emergency, and we need to initiate the Hour One Bundle upon recognition of sepsis.  The goal wasn't that everything needed to be completed in one hour. We recognize that that's virtually almost impossible,  so we wanted hospitals and clinicians to do their best to initiate the bundle within one hour of recognition.  Again, this was just to improve the quality of care and initiate treatment as soon as feasibly possible. This was not for any regulatory agencies or anything like that.  Most of us are still using the three- and six-hour bundle in the U.S. CMS,  but again, this is to drive home that early recognition and early initiation of treatment can make a difference.  In the final part of this talk, I'm going to give you some information about multidisciplinary team approach,  which really may be the key to everything working smoothly, the value of a multidisciplinary approach to resuscitation.  This is a picture of our team in the ICU, and you can see there's lots of smiling faces, which is what we hope. In order for it to have a good, functioning multidisciplinary team,  we really would prefer that everyone's happy and they're content with everything that they're doing.  You can see here there's physicians, respiratory therapists, medical students, fellows, residents, nurses, really encompassing everything that we do.  There's some benefits, lots of benefits of a multidisciplinary care team. Improved outcomes, patient satisfaction, improved use of resources, improved patient safety,  decreased length of stay, which converts into costs, lowering costs, improved health outcomes, and again, enhanced job satisfaction.  It's important we give our teams what they need to be confident, so we need to provide knowledge, skills, and attitudes.  One such study looking at top-performing hospitals versus non-top-performing hospitals in cardiac arrest.  This is detailed interviews were conducted with 158 clinical and administrative staff in nine hospitals  that were participating in the Get With The Guidelines resuscitation registry. Basically, what they looked for were four themes. This was a qualitative study.  They looked at team design, team composition, and roles, communication, leadership during in-hospital cardiac arrest, and education.  So really what they found was that in top-performing hospitals, they had dedicated and designated teams,  whereas in non-top-performing hospitals, they generally had non-dedicated teams that are used like an ad hoc team.  The team compositions were similar, but top hospitals actually had more support staff, such as pharmacy, clerical, security, and spiritual staff.  As far as communication, communication and leadership encouraged multidisciplinary discussion and mutual respect.  In non-top-performing hospitals, they described the chaotic or confusing gaps in practices.  When we look at training and education, in non-top-performing hospitals, it was not routine,  but in high-performing hospitals, they actually implemented mock codes that were regularly scheduled.  They conducted them in patient rooms and high-risk areas, and again, they were multidisciplinary. They also did debriefing.  This study also, the information from these interviews were also converted into looking at nurses' roles in in-hospital cardiac arrest.  So again, this is the same 158 interviews, but looking at nurses' roles.  So in high-performing hospitals, there was a significant amount more of mentoring, debriefing, and identification of training needs.  The hospital used data to evaluate and address training and nurse needs.  And again, when you think about nurse empowerment, high-performing sites envisioned nurses as clinical leaders and champions.  So nurses do certainly play a large role in in-hospital cardiac arrest and are a big part of the multidisciplinary team.  And similarly, if you're considering implementing a ward substance detection program, there are some critical steps prior to implementation of this program.  But it's actually even more broad. So it's important that we have administrative support, that we have funding for data collection, if that's what we're going to be doing,  that we have a project lead, and we need informatics. So even part of our multidisciplinary team for a sepsis detection program, we really needed our informatic support.  And here's where the multidisciplinary piece comes in as far as clinicians.  We needed to align the wards, so the medical-surgical or the step-down units, with what was happening in the emergency department and the ICU.  We all need to be on the same page and work together. Sepsis was not something that we needed to think of in silos.  We needed to think of this as a hospital-wide issue that we needed to improve. We needed to identify one particular unit.  We also had to have champions, like who was actually going to be our champions. And we needed them on each shift.  We also needed to preview the workflow, so one unit may not flow like another unit.  So this is very different, and it included not only a multidisciplinary team, but a multifactorial team across departments,  which leads me to think that not only are multidisciplinary teams important with the care that we deliver, but we need to have cross-departmental collaboration.  So whether you work in the emergency department, in the critical care unit, or in a medical-surgical floor, we all need to work together.  There's no way that we can improve care or monitor patients for deterioration or care for them.  After we recognize deterioration, it's key that we work together as an institution, not necessarily in silos.  So again, cross-departmental multidisciplinary teams are really what's going to make a difference. So with that, I appreciate the time that you spent with me today  talking about reducing in-hospital decompensation, sharing some information about early substance recognition and resuscitation,  and again, the value of the multidisciplinary approach to resuscitation. So I thank you for this honor again and for your time. Have a good afternoon. ♪

Video Summary

Dr. Krista Schorr, an Associate Professor of Medicine and Clinical Nurse Scientist, delivered a lecture titled "Avoid Running on Empty: Applying a Focused Approach to Resuscitation" as part of the Asimov-Lehrer Lecture series. Dr. Schorr has been involved in critical care medicine for a long time and has contributed to the field through her work in the development of the Surviving Sepsis Campaign performance improvement software. She discussed the importance of early sepsis recognition and resuscitation, as well as the value of a multidisciplinary approach to resuscitation. Dr. Schorr highlighted the need for a system to identify deteriorating patients and appropriate intervention for response. She also discussed the challenges faced in preventing in-hospital cardiac arrest and the need for rapid response teams. Furthermore, Dr. Schorr emphasized the importance of screening for sepsis and implementing performance improvement programs. She presented various studies and initiatives aimed at improving outcomes for sepsis patients, including the Hour One Bundle that focuses on beginning resuscitation immediately. Dr. Schorr concluded her lecture by stressing the benefits of a multidisciplinary care team in achieving improved outcomes, patient satisfaction, and resource utilization.

Asset Subtitle

Resuscitation, Quality and Patient Safety, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Identify steps to decrease in-hospital patient decompensation
Discuss the role of early sepsis recognition and resuscitation management to improve patient outcomes
Evaluate the value of a multidisciplinary team approach to resuscitation

Avoid Running on Empty: Applying a Focused Approach to Resuscitation
Christa Schorr

Meta Tag

Content Type Presentation

Knowledge Area Resuscitation

Knowledge Area Quality and Patient Safety

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Cardiac Arrest

Tag Scoring Systems

Tag Guidelines

Year 2021

Keywords

Dr. Krista Schorr

Surviving Sepsis Campaign

early sepsis recognition

multidisciplinary approach

rapid response teams

screening for sepsis

performance improvement programs

Hour One Bundle

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