Sepsis is the overreaction of the body’s response to infection. Instead of just attacking the infection, the body releases chemicals that also attack healthy cells, resulting in organ damage and death.
The challenge in treating the condition, which kills approximately 258,000 Americans and costs the U.S. health system $24 billion each year, according to Sepsis Alliance, the largest U.S. sepsis awareness organization, is to diagnose and treat it in the early stages.
“The higher the severity, the higher you have the risk of dying,” said Dr. Andre Vovan, executive medical director of clinical effectiveness at St. Joseph Hoag Health in Irvine.
Vovan was recognized at the Business Journal’s third annual Innovator of the Year Awards at Hotel Irvine on Sept. 12 for saving patient lives (see related stories, pages 1, 14, 16 and 17).
“The innovation we’ve done … is in re-engineering of the care delivery model to ensure, improve and rewire how hospitals operate to improve care quality and outcome,” he said.
He was also honored at Sepsis Alliance’s Sepsis Heroes fundraising gala in New York, held two days after the Business Journal event.
Scale
Following the New York ceremony, Vovan traveled to Seattle to lead a meeting on how to implement sepsis protocol throughout Renton, Wash.-based Providence St. Joseph Health and its 50 hospitals.
“It’s an engineering challenge for me,” he said, pointing out that he started with one hospital in 2004. “We designed the program in a very deliberate manner [so] the right care happens at the right time, at the right setting and with the right provider.”
He implemented the program at St. Joseph Hoag when the two healthcare systems formed an alliance in 2013, and eventually extended it throughout the St. Joseph Health system.
More hospitals are addressing sepsis after the Centers for Medicare & Medicaid Services expanded publicly reported outcome measures in 2015 to include sepsis. The Affordable Care Act changed the way hospital services are paid; the quality report on a hospital’s care affects the payments it gets.
Sepsis is a three-stage condition, progressing through early-stage sepsis to severe to septic shock. There are several problems with traditional sepsis treatments, including failure to diagnose it in the early stages, when symptoms such as fever and chill may be confused with other conditions, Vovan explained.
He said 80% to 90% of sepsis patients come through the emergency room and that care given in the first three to six hours is critical.
Vovan has helped standardize diagnosis and treatment, established a separate sepsis floor where clinicians can focus on care of the condition, and co-developed app AcesoCloud to help with screening and treatment tracking.
He also introduced staff-education programs on recognizing sepsis, creating a group of dedicated sepsis nurses at the hospitals who respond to “code sepsis” calls. The nurses identify and monitor patients at risk of sepsis, such as those with urinary tract infection and pneumonia, in the first critical hours of treatment.
St. Joseph Hoag saved more than 250 lives last year, resulting in about $8.5 million in cost savings, according to a spokesperson.
Vovan has presented the sepsis team’s findings throughout the country, including to the Institute for Healthcare Improvement.
Problem-Solving
Vovan, who received his medical degree from the University of California-San Diego and a master’s in business administration from the University of California-Irvine, said his education helped him with the task.
“I studied engineering, and about a year from finishing, I went into medicine. But the skills of IT and engineering stuck with me. Sepsis is a disease that’s not about a new drug or a new medical device, but ensuring care consistency.”
Vovan said his inclination toward medicine comes naturally. His father is a doctor and his mother a pharmacist. He has three brothers and three sisters—including two sets of twins—and four of them practice medicine.
“I like physics, I like math, I like teamwork, and I like solving problems, but I didn’t get the immediate gratification I would get in medicine at the end of the day if I saved somebody’s life,” Vovan explained.
He laughed, saying, “medicine is my life,” literally. He even named his three children after his favorite medications: Tyler for Tylenol, Zoe for Zosyn, an antibiotic, and Dylan for Dilantin, used for anti-seizure treatment.
Work for him doesn’t stop with sepsis. He’s in the process of reapplying what he learned from the sepsis-treatment standardization into other diseases. “The problem is … most care is not standardized, because it’s very expensive and labor intensive to put together these programs. We want to lower the barriers to creating standardized care [that’s] easily scalable for other disease management,” such as congestive heart failure, gastrointestinal bleeding and chronic obstructive pulmonary disease.
