Running head: HEALTHCARE FINANCE REFLECTION PAPER 1

Healthcare Finance Reflection Paper

Stephen Newbern

Jacksonville State University

NU710 Healthcare Policy and Finance

Dr. Lori McGrath

April 12, 2019

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Healthcare Finance Reflection Paper

Septicemia, also known as Sepsis, is a potentially dangerous medical condition that is

associated with the progression of a bacterial infection in the body. The body's overwhelming

systemic response to the disease can lead to organ failure, tissue damage, and possibly death. A

particular pathogen does not cause septicemia but instead occurs when infection runs unchecked

in the body, and organ systems begin to fail. As a result, many times other diagnoses are

assigned to a patient's condition when in actuality septicemia is the underlying cause. The

solution that will allow nurse practitioners to identify sepsis and reduce septic related mortality

rates is early detection and intervention. The goal of this research project is to determine if the

use of computer monitoring systems can be useful in reducing the amount of time it takes to

recognize a septic condition and initiate effective medical interventions utilizing the guidelines

and protocols established by the Surviving Sepsis Campaign (Dellinger et al., 2013).

Statement of the Problem and Purpose of the Study

Early detection of patients entering into a septic state in the hospital setting has been

identified as the most essential tool in combating the deadly diagnosis (Kurczewski, Sweet,

McKnight, & Halbritter, 2015). Objective measurements of vital signs and lab results are

valuable cohesive indicators that are interdependent and important in diagnosing septic

conditions. Analyzing these values is easy to do with a computer program, but clinical data is

only relevant if someone acts upon it in a timely fashion. Clinical staff must be trained to

recognize septic conditions and have evidenced-based protocols in place as guidelines for action

when septic conditions occur. Before the advent of using electronic medical records and

monitoring software, identifying a septic condition was not a consistent practice. Typically this

was left entirely to the critical judgment of the caregiver, nurse, or practitioner. Using computer
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software to monitor and alert for septic criteria thresholds is a new paradigm in medical care that

can assist and enhance patient care across a wide variety of educational backgrounds and

experiences of care providers.

Process of Implementation

A common theme that has emerged from research gathered is that measuring the

variables of sepsis detection are very objective and concrete because objective values such as

heart rate, temperature, or respirations are for the most part concrete. However, the accuracy of

measurements used to identify sepsis can be affected by human actions and judgment. A

common thread of framework development throughout many research articles in this study is a

foundation in the General Systems theory initially proposed by Ludwig von Bertalanffy (Butts &

Rich, 2011). Bertalanffy theorized that dysfunction in one system affects other systems in an

organizational unit. The vital sign criteria that define sepsis for our research fits this category,

and this theory will help to identify the impact that each of the variables of analysis has.

The overall purpose for designing automated alert systems to detect septic conditions in

patients is to 1) reduce the amount needed to identify a septic condition, and 2) to initiate

lifesaving interventions. Early intervention in detecting sepsis is key and interventions performed

within the first hour can have a significant impact on reducing sepsis-related deaths by fifty

percent (Damiani et al., 2015). Kurczewski et al. (2015) noted in their research that the use of

computer-based alert systems was effective in reducing the timeframes to begin interventions for

patients diagnosed as being septic (Kurczewski et al., 2015). Many studies on computer alert

systems focused on critical care patients in ICU or post-surgery, but Kurczewski noted that their

research was particularly beneficial for hospital patients that were not in a critical care unit and

positioned in general ward areas. Patients in the general wards were not monitored as closely as
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patients in ICU, and their sepsis mortality rates were higher because identification of septic

conditions was delayed due to a lack of focused observations (Kurczewski et al., 2015). Harrison

also noted that the generation of false-positive alerts would be reduced when the ability to

minimize human error was also decreased (Harrison et al., 2015).

The human component of utilizing computer-based monitoring systems is critical. A

computer may generate alerts, but a human nurse or staff member must act for the warnings to be

useful. Sawyer et al. (2011) noted in their research that educating staff members about the

pathophysiology of sepsis, providing sufficient training, and providing appropriate clinical tools

for monitoring and detection, improved the accuracy of early detection of septic conditions

(Sawyer et al., 2011).

Expenses

Expenses to implement the experiment are fairly nominal outside the cost of salaries for

research personnel. Research personnel will only be needed to start the software at the beginning

of the study, terminate it at the end, and analyze the data at the end of the study. During the

study, the software will generate alerts that will be presented to medical staff for further action.

Analysis by researchers at the end of the study will determine if the software has been effective

in reducing the amount of time to present an alert to detect a septic condition. In total, an

estimate of 10 hours will be needed for each research member. The estimated total cost for

salaries is $200 (10 x $20/hour). There is a one-time initial equipment purchase of $500 for a

computer, monitor, keyboard, and mouse. Depending on the electronic health record software

vending license, there may be a fee to utilize a development library to access patient data, but for

this study this was ignored since the price can vary from free to thousands of dollars. An

additional fixed cost to include is for the printing of patient education material which should cost
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no more than $2.00 per patient. The total cost for the study is estimated to be $1,430 (200 * 1.15

+ 500 + 2 * 350). A 15% buffer should be allotted for salary variance. An additional funding

source may be needed if the hospital does not have a spare computer that can be used and is not

willing to help with printing and salary cost.

Implications for Practice

The use of computer software in the medical field will undoubtedly continue to become

more popular in the future because computers give human practitioners the ability to multitask

more effectively. Computers never get tired, and they can follow instructions (programming)

consistently with every patient, every hour of the day, in a variety of environmental settings.

Nurses and practitioners in medical organizations worldwide are taking on increasing loads of

responsibilities surrounding patient care. Without the aid of computer automation, the ability to

monitor and react to critical conditions will be greatly decreased. The most important aspect of

understanding the use of computer software in the healthcare environment is that computer

programming is nothing more than a reflection of the programmer's mind or thought processes. If

those original thought processes were created upon evidenced based practices, principles, and

guidelines, then the resulting software that is created can be a perfect model of established peer-

reviewed research. Computer software can be a useful tool but should never replace the critical

judgment of a skilled practitioner.

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References

Butts, J. B., & Rich, K. (2011). Philosophies and theories for advanced nursing practice.

Sudbury, Mass.: Jones and Bartlett Publishers.

Damiani, E., Donati, A., Serafini, G., Rinaldi, L., Adrario, E., Pelaia, P., . . . Girardis, M. (2015).

Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and

Mortality: A Systematic Review and Meta-Analysis of Observational Studies. PLoS One,

10(5).

Dellinger, R., Levy, M., Rhodes, A., Annane, D., Gerlach, H., Opal, S., . . . Moreno, R. (2013).

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis

and Septic Shock, 2012. Intensive Care Medicine, 39(2), 165-228. doi:10.1007/s00134-

012-2769-8

Harrison, A. M. B. S., Thongprayoon, C. M. D., Kashyap, R. M., Chute, C. G. M. D. D., Gajic,

O. M. D. M., Pickering, B. W. M. B. B. M., & Herasevich, V. M. D. P. (2015).

Developing the Surveillance Algorithm for Detection of Failure to Recognize and Treat

Severe Sepsis. Mayo Clinic Proceedings, 90(2), 166-175.

Kurczewski, L., Sweet, M., McKnight, R., & Halbritter, K. (2015). Reduction in time to first

action as a result of electronic alerts for early sepsis recognition. Critical Care Nursing

Quarterly, 38(2), 182-187. doi:10.1097/CNQ.0000000000000060

Sawyer, A. M., Deal, E. N., Labelle, A. J., Witt, C., Thiel, S. W., Heard, K., . . . Kollef, M. H.

(2011). Implementation of a real-time computerized sepsis alert in nonintensive care unit

patients*. Critical Care Medicine, 39(3), 469-473. doi:10.1097/CCM.0b013e318205df85