Researchers and clinicians from the Division of Pulmonary and Critical Care at Intermountain Medical Center and LDS Hospital have shared Intermountain’s care processes and best practices with an international audience: The division’s members delivered three symposium presentations and presented 18 abstracts at last month’s American Thoracic Society International Conference.
The focus of our presentations: How we’re improving care processes. “This is the number one conference in the world for pulmonary and critical care physicians, and our active role there demonstrates to an international audience how active we are in research, quality improvement, standardization of care, and improved clinical outcomes,” says Nat Dean, MD, Chief of Pulmonary and Critical Care Medicine at Intermountain Medical Center and LDS Hospital.
Intermountain’s presentations focused on the translational research we do, which takes findings from the laboratory and applies them to clinical settings. “Our emphasis is converting science into changes in clinical practice,” says Dr. Dean. “Intermountain Healthcare generally is well-known for improving the quality of care, and our division is recognized for improving care for patients with asthma, sepsis, pneumonia, pulmonary nodules, pulmonary hypertension, acute respiratory distress syndrome, vasculitis, and a range of other conditions. Our posters and presentations are evidence of the effectiveness of the best practices we’re developing and using.”
One example of how our research helps improve care: Intermountain’s sepsis bundle. Russ Miller, MD, MPH, gave a well-attended oral presentation at the conference on the impact of our sepsis bundle. The bundle is a group of best practices, performed sequentially, that outlines how to care for patients with severe sepsis, which is a life-threatening complication of infection that can lead to organ failure and death. Dr. Miller, who is Medical Director of the Respiratory ICU at Intermountain Medical Center, also chairs the Critical Care Development Team for Intermountain Healthcare’s Intensive Medicine Clinical Program.
“Russ is an international leader in sepsis care who published a paper a year ago in the American Journal of Respiratory and Critical Care Medicine, which led to his invitation to present at the conference in May,” says Dr. Dean. “He showed how we determined that if you take this standard set of steps with patients with severe sepsis, they do much better. We’ve gone from a mortality rate of 20 to 25 percent to less than 10 percent, compared to a national mortality rate of roughly 30 to 40 percent. That’s astounding. Russ was invited to tell the world how we did it.”
Dr. Miller says, “Once you publish something, you tend to spur interest, which is one reason why you publish — you have a message to share.” His message at the American Thoracic Society conference: “High compliance with recommended best practices can yield substantial improvements in outcomes, especially mortality,” he says.
How did clinicians at the international conference react to Intermountain’s results? “There were two responses — congratulations and disbelief,” says Dr. Miller. “The disbelief comes from the fact that our mortality is so incredibly low compared to published data, and the key to our success is having a high rate of compliance with best practice. Our compliance rate is at least twice the rate of any other published group that’s rigorously investigated sepsis care in the United States.”
And how do we produce such extraordinary compliance? “Our clinical programs help vertically integrate our care processes, so everyone’s on the same page, from hospital and system leaders to bedside clinicians,” says Dr. Miller. “That integration makes Intermountain Healthcare unique. Our success is based on our ability to get the entire corporation on board with our best practices, especially our dedicated bedside nurses.”
Dr. Dean adds: “Implementing the sepsis bundle requires integration and organization, which are two of the things Intermountain Healthcare does best. In most places the ER and the ICUs are separate, but our processes require us to all work together, from recognizing sepsis earlier in the ERs to rapidly moving patients to the ICU to the early administration of fluids and antibiotics. Part of what we do better at Intermountain is work collegially and interactively; we have ER doctors working with intensivists and nurses and pharmacists talking to each other. That’s a hallmark of Intermountain Healthcare.”
The researchers and clinicians in Intermountain’s Division of Pulmonary and Critical Care also work closely with their counterparts at the University of Utah Medical Center. Many of Intermountain’s clinicians have full academic appointments at the U., the two programs operate a combined fellowship program, and many of the first authors of presentations at the American Thoracic Society conference are medical fellows, residents, or students who work together in both programs.
The 17 people from Intermountain who presented or spoke at the conference are faculty members Nathan Dean, MD, Russ Miller, MD, MPH, Denitza Blagev, MD, Colin Grissom, MD, Samuel Brown, MD, Ellie Hirshberg, MD, Michael Lanpsa, MD, Alan Morris, MD, Olinto Linares, PhD, and Stacy Bamber, PhD; fellows Daniel Knox, MD, Lindsay McCauley, MD, and Barbara Jones, MD; residents Hannah Gaedtke, MD, and Andrea Gutsche; and medical students Paula Porter Griffith, MD, and Christina Pratt.