Breaking Down Barriers to Care: Sepsis
Download MP3Hello, everyone, and welcome to Culture of Health. It's a show that zeroes in on health care matters as they disproportionately affect our communities. And we highlight ways to break down systemic barriers to quality of care. On this podcast, we'll talk to healthcare professionals and hear stories that inspire and inform listeners to bravely navigate health care with dignity, care, and humanity in order to achieve equity. I'm your host, doctor Wando Anyoku.
Dr. Anyaoku:I'm the chief health equity and clinical innovation officer at Providence. And here with me today are doctor Shelley Schoepflin Sanders, who is a clinician, educator, and the chair of the Providence sepsis focus group, and Moojan Rezvan, who is the supervisor of interpreter services and diversity services. And they're both going to help us today to better understand critical issues surrounding sepsis. Why are ethnic minorities more likely to develop sepsis or have complications compared to other populations? And some of the things that, you know, we put in place to deal with this.
Dr. Anyaoku:So let's get started by welcoming our guests, and I will ask for them to introduce themselves and tell us a little bit about what they do. Doctor Sanders, can I start with you?
Dr Sanders:Yes, doctor Enyoku. It's just such an honor to be here with you. Thank you for having me. Yes. I am a clinician educator.
Dr Sanders:So I am a general internist, and I teach doctors. So my role is to educate residents, but I'm also very active in quality improvement for Providence. And I am a Providence Health Equity Fellow this year working to build equity into every one of our quality measures, specifically the one I work on the most, which is DEXIS.
Dr. Anyaoku:Fantastic. Thank you. Moojan?
Moojan:Hi, everyone. Thank you so much for having me. It is definitely an honor to be here with these two amazing individuals. My name is Mujan Rezvan. I oversee the interpreter services department at Providence Mission Hospital, and I've been in the health care industry for a little over 4 years.
Moojan:I'm a health care administrator. So I bring, not a clinician, but I, work in the administrative part of the health care and, quality improvement, making sure our patients have everything they need, and our clinicians have everything they need to take care of our patients.
Dr. Anyaoku:I am so honored to have both of you on this call on this podcast today. And before we start going into the health equity issues, which we'll spend most of our time talking about, shall we set a little ground, you know, level setting for our audience? What exactly is sepsis? Why is it important for our public to have a basic understanding of it, and what are the challenges that we see in this particular area? Doctor Sanders, would you like to start?
Dr Sanders:Sure. Sepsis is actually a leading cause of hospital death. It's the final common diagnosis for many patients who are living with chronic illness like cancer or diabetes or even chronic lung, kidney, liver disease. Sepsis is the body's overwhelming and toxic response to an infection. So an infection might start in your lung, and instead of being contained there, the body's inflammatory response goes through the whole body.
Dr Sanders:And patients with sepsis feel very sick. They present often with a fever, often with low blood pressure, weakness, a fall, or even altered mental status.
Dr. Anyaoku:Wow. And it is something how common is this? How how often does it show up in our hospitals? I know you said it's the final diagnosis for a lot of conditions, but, you know, how would how often would you say this is something we have to look out for?
Dr Sanders:Yeah. Sepsis is very common. It's probably 1 in 3 patients who pass away will have sepsis during their stay. But I think important for this audience to realize is that sepsis, while it comes from an infection, most infections that people face in the community are really from viruses. And while viruses technically can cause sepsis, most of the time, it's a bacterial infection that's a little more localized.
Dr Sanders:So someone might have a bladder infection that then spreads, and they're developing fever or other symptoms, or they might have a red spot on their leg. That's important to get care for that, but that's not sepsis unless it's also causing this weakness, altered mental status.
Dr. Anyaoku:Okay. So as we talk about in culture of health, we really focus on disparities in different populations. So, Mujan, how do we see these differences in different populations? Are there some groups that experience this more than others, or how are these differences seen in sepsis?
Moojan:So, yes, different population may experience it differently, based on their body. I think doctor Sanders can really speak to that better than me, but also based on the culture that they have or the the level of education they have or the level of understanding they have from how this works, when and where to go to the hospital, when to seek care. So I can speak to something that we are working on in our hospital. We are doing quality improvement project on a population with sepsis, and we found out that patients who are LEP, limited English proficient, meaning English is not their first language, may experience the whole journey differently because of multiple reasons. Because maybe not everything was explained to them correctly.
Moojan:Maybe they didn't understand everything, or they just had another, vision, or they were thinking something else, but something else actually happened or didn't ask good questions about what to expect after I leave the hospital. So they experienced it different differently in that matter. And then as far as race or ethnicity goes, I think doctor Sanders can really speak to that.
Dr. Anyaoku:Doctor Sanders? Can you tell us a little bit about the equity issues in in sepsis?
Dr Sanders:Yeah. Sepsis is no different than, I'm sure, your other disparities. And some numbers from the sepsis alliance. People of color are twice as likely to get sepsis. They're more likely to have severe sepsis, and they're more likely to pass away from their sepsis.
Dr Sanders:And so what we're trying to do again is raise awareness, but without frightening people. I think all of us, you can hear I've got a virus in my voice. Viruses are rampant, and you can feel terrible and still just have a virus. So I think it's important for people to be aware of sepsis, but also to understand that if you just have a frog in your throat and a cough and it won't go away for weeks, that is not sepsis. Sepsis is truly devastating severe illness, often starts with one spot in your body and then spreads.
Dr Sanders:And the things to watch for at home would really be serious vital sign abnormalities, high fever or low blood pressure or a fall or confusion so that people don't go to the emergency room just with a virus upper respiratory infection.
Dr. Anyaoku:This is so helpful. So if, you know, if I put those two statements together, it seems to me that things that could be common, you know, we may assume their common illness may actually be a more serious condition on the way to sepsis. And, Mujan, from your your description, the people with limited English perfect proficiency or for whom English is not a first language may actually not have the tools to recognize that something is different than a regular cold or regular viral illness. And this is it's so important as we talk about health equity because sometimes people think, well, everybody can have that. Why why are we paying particular attention to this population?
Dr. Anyaoku:But what you're saying makes a lot of sense in that it may be common to everyone, but everybody doesn't have the same tools. So how are you, in your work, looking at mitigating some of these differences, identifying them and doing something different? Can you talk to us a little bit about that?
Moojan:I can start. So I think going back to the definition of equity, we need to recognize the need and understand that everybody doesn't have the same need. And if we provide the same services for all of our population, that's not equity. That's quality. Right?
Moojan:It's everybody is the same. We're doing the same exact thing for everybody. But we understood that not everybody has the same needs. Some populations may need more of our attention, may need just more of our services. So at our hospital, we started an initiative working with LEP patients, working with people that English is not their first language specifically and focusing on those population.
Moojan:We translated our educational material into our top four languages in our hospital because we wanna make sure people understand their disease in their preferred language. We have bilingual staff that are working with these patients. We have comprehensive interpreter services, interpreters available if patients have any questions. Because being in a hospital is one thing, and not understanding what's is one thing, Feeling vulnerable, not being the being able to ask the questions you want in the language you understand. Some of our patients do speak English, the broken English.
Moojan:With the broken English they have, they're really trying to get their point or ask a question, but we wanna make sure they feel comfortable. They know these services are available for them. So really offering everything based on the language, the the culture they have, and aligning it with their level of understanding. So I think that's something that we can really say it's working and it's successful and we're doing it and patients are absolutely loving it.
Dr. Anyaoku:That's fantastic. Doctor Sanders?
Dr Sanders:Yeah. I'll just piggyback on what Mongeon's doing. Here at Providence, we have some very carefully designed workflows because sepsis is a medical emergency. So prompt antibiotics, IV fluids, lots of vital signs. A patient experiences that urgency when they come in, and they can feel that the staff are paying a lot of attention to them.
Dr Sanders:But it can be upsetting or worrying, right, to to have that flurry of activity, have your sleep disrupted. And so to try to help, we've got order sets that the physicians and the nurses and the pharmacists use and linked to that order set in our electronic health record is our educational material. And we ask our nurse to provide that at the bedside as a printout early in the hospital stay. We now have that in 10 languages. And then part of the fellowship work has been to work specifically here in Oregon.
Dr Sanders:We saw a disparity with more readmissions for our black patients. So we were able to invite our black patients to in person focus groups where they told their story, And we brought a graphic designer, a novelist, to the sessions, and he began to sketch, like, a story line, a narrative of common features that people were describing as they experienced sepsis starting from often an ambulance ride and then going through the hospital stay and kind of ending with recovery at home and recognizing that once you've lived through sepsis, which can be life threatening, you often are left fatigued. You may have brain fog. You may need rehab and support at home. And so he's built this beautiful graphic novel that we will also translate into 10 languages, and it's a different form of education.
Dr Sanders:We call it narrative education. It's story based, and we're finding that it seems a little easier for folks to listen to a story of someone else. There may be pieces of that that are similar and dissimilar, but it does get a jumping off point. And our focus group members really emphasized how important their primary care was in their journey to full recovery, bringing any post sepsis complaints to your primary care who can help you control those and also control the underlying conditions that you at risk for sepsis in the first place. So we're really excited about that new education, and then we also have 2 videos that are coming out.
Dr Sanders:Mujan made one that is very educational. And then we have a second one that is truly our couple of our black sepsis survivors who were willing to share their story along with an intensivist who is narrating and giving some education that kind of runs alongside that in a short video.
Dr. Anyaoku:My word. I mean, you just lifted my spirits just listening to these these two different states. Right? Different facilities, but all with the same mission. Right?
Dr. Anyaoku:To provide high quality equitable care to our patients and our communities. And what you described is just so heartwarming. It's recognition of the value of each of our patients, right, their unique backgrounds, and and engaging with them really from a place of compassion and enhancing their dignity. And this is so incredibly powerful. I I'm grateful for all that you're doing for our communities.
Dr. Anyaoku:How do we can people get access to these resources across a a whole enterprise? Can they reach out and get these videos or get a playbook, Mujan, from what you're doing? How How can we learn from one another to extend the impact of this work?
Moojan:Yes, definitely. After they're all done, and ready for publish, we can, share it with everybody. I think the goal is to put it on Epic, right, Doctor. Sanders, make it available on Epic so all of our nurses, doctors are able to print it and give it out to patients. The videos will have a QR code on the same file, and patients can just scan it with their personal devices.
Moojan:Family members can scan and watch them, or we we have hospital provided devices that they can use and watch the videos. And, really, the purpose of these videos is to bring awareness. They're very simple, easy to follow with graphic, and we really try to use simplicity because we want everybody everybody to understand what is sepsis, what to look for, and when to come to the hospital, what to expect after you have sepsis in a very simple language for everybody to understand.
Dr. Anyaoku:Awesome. Go ahead.
Dr Sanders:I'll just chime in because you mentioned the importance of really connecting with our community and listening to their needs, And I just wanted to give a shout out to Nisha Fox who helped mentor me in this project. She has a whole master's degree in community based participatory research, which is kind of a reframing and a recommitment that nothing we do in health care happen in a silo, in an office where we think it sounds like a good idea, but that everything really goes through multiple stages of having our community members review the materials. And it was that's what we did with this narrative education. We had multiple meetings. We brought the draft.
Dr Sanders:They reviewed it. Then we went to our physician and clinician experts and said, is this still medically accurate? But then we took that back again a third time. And it's been really enlightening to me. I've been a doctor 20 years, and I feel like I know what patients want and need.
Dr Sanders:But when you listen carefully again and again, you deepen your understanding, and the materials you produce are more true to what the questions really were that they were having. And I'll tell you that narrative education reads very differently than the bullet points we came up with the first time when we went to 1 patient family advisory council. So I I just wanted to share that because I think it's a direction we're all trying to go, which is to really listen first before we try to speak.
Dr. Anyaoku:Oh my goodness. I I could not thank you. Just 10 x that.
Moojan:I can I can also add to what doctor Sanders just mentioned because we did something very similar down in our hospital as well? We knew there was a disparity between English speaking and non English speaking population, but we really didn't know why. We had hypothesized before. We we thought about, okay. It might be this.
Moojan:It might be that, but we really wanted to lessen, listen to the patients, the community, the people that actually experienced sepsis. And we wanted to know why did you think you you ended up staying longer in the hospital compared to an English speaking patient. Do you think it had anything to do with our care, or do you think it had anything to do with the way that we explain things to you or language access. So we invited former patients as well. We did a whole Spanish speaking patient focus group.
Moojan:The whole meeting was done in Spanish. Our moderator were was talking in Spanish because we really wanted to listen to the patient and see what they had to share. And after what they shared with us, we broke it down into different categories. We're like, okay. These are the things that we need to focus on.
Moojan:And that really helped us move the needle in the disparity, portion of it. And, the data now is looking better because we're really focused on what they shared with us.
Dr. Anyaoku:Oh, my word. You know, a lot of times as clinicians, we think quality care means everybody gets exactly the same thing to the point you made earlier. But what you both described is just how critical it is to partner with the community so that we actually understand what their limitations are, and we're able to achieve our goal, which is always high quality and safe care, but achieve it in a way that actually lands for that community and eliminate disparities. You, just describing the the dream. Right?
Dr. Anyaoku:This is the dream. This is how we achieve the goal of high quality, equitable care for every member of our society. And I I, you know, I just want to sing, but I don't think it'll be a good thing for anyone if I sing. So let's not go there.
Moojan:This is weird.
Dr. Anyaoku:So what would you ask people to know? What what is your call to action? Right? What what do you want people to take away from this conversation? What should they see at home?
Dr. Anyaoku:What should they see as clinicians? What would you like people to take away as they're to do from from listening to you this morning?
Dr Sanders:Yeah. I'll say recognizing substance is a serious medical condition. And I think the best advice is if you're worried, I am too. So if your mom is confused, she's drowsy, she's falling, there's something wrong. She's not usually confused, drowsy, or falling.
Dr Sanders:So even if she's not telling you it burns when she goes to the bathroom, it's worth bringing her in for assessment. I would say that distinction of is this person sick, meaning different than they usually are, is probably the best tip I have in terms of recognizing sepsis early. Seek care, whether that's calling the nurse advice line, whether it's going to urgent care, or if it seems serious going on into the emergency room. And then in terms of equity, I just I really recognize with humility that we are just beginning our journey. And so I don't wanna place a burden on people who may be coming already from a place where they may not have trust or they may have already been facing discrimination.
Dr Sanders:And yet I just have such gratitude to those who are willing to stay in that dialogue and to speak up and correct us where we're going astray. We really want to listen. We want to do good work, and we are so grateful to those who are willing to participate as Mujan and I have experienced in these focus groups. It's really helping pay it forward so that we can do better in the future.
Dr. Anyaoku:Yeah. Thank you.
Moojan:So, thank you, doctor Sanders. Exactly everything you said, I completely agree with. And, just to add to it, my call to action would be for people that are listening to this. Know what sepsis is, know the symptoms, and talk about it with your family and friends. Hey.
Moojan:Did you have you ever heard about sepsis? Do you know what sepsis is? If you go around and ask your family and friends, do you know anybody that had a heart attack? Everybody knows someone that had a heart attack or a stroke. But if you ask around, do you know anyone that had sepsis?
Moojan:Probably they would say, what is sepsis? And that's the awareness that we really wanna bring to the table. We really want our audience to know what sepsis is and talk about it between family and friends, know who is more at risk and what signs and symptoms to look for and when to go to the hospital and really seek care. So that would be, one thing. And then in some languages, sepsis doesn't even have a direct translation.
Moojan:So whatever language you speak or if you know another language, really find out what it's called in your language. Like, I'm a medical interpreter in Farsi, and I know in Farsi, there is really no word. We just call it sepsis again, but in Arabic, it's a complete different thing. So different languages calling a different thing, find out what it is if you speak another language, and talk about it and bring awareness to the community or your friends or your family. And that would be my suggestion.
Dr. Anyaoku:Oh, my word. You too ladies just demonstrate such amazing work, compassion, and commitment. You know, a lot of us if we're sitting in a hospital and you're thinking, how do we get patients to go home in a shorter period of time? We're managing length of stay. And we're missing the fact that some people are staying longer because we're not communicating effectively.
Dr. Anyaoku:So, you know, initiatives like this and and just this approach to delivering high quality care makes a difference all across the entire continuum and empowering the community to ask questions, to know what they don't know, what they didn't know that they had to know. Right? So really having this educational approach to it is incredibly powerful. I wanna thank you so much, doctor Shelley Sheffley Sanders and Mojan Rezran for really bringing gold standard to our conversation this morning, for bringing your your a game and to culture of health to talk about this important topic and the ways we're addressing health equity issues surrounding sepsis. We are going to continue to do this these conversations and health and wellness with more experts from Providence around the Providence Enterprise in future episodes.
Dr. Anyaoku:I wanna thank you all for joining the Culture of Health conversation this morning. Please subscribe to Culture of Health on your favorite podcast platform, and make sure to listen to all our shows on Letlive Radio under the Future of Health or on your favorite podcast platform. You can follow us on social media. We can be found on Twitter and Facebook at Providence and Instagram under Providence Health Systems. To learn more about our mission, programs, and services, please go to providence.org.
Dr. Anyaoku:And please remember that the information provided during this program is for educational purposes only. You should always consult with your health care provider if you have questions regarding a medical condition or treatment. Thank you for listening. And remember, at Providence, we see the life in you.
