Tackling Sepsis in Hospitals

The statistics are grim. Each year in the United States, at least 1.7 million adults develop sepsis, and nearly 270,000 of them die as a result of it. What’s more, one study showed one in three patients who died in a hospital had sepsis;¹ however, 86.8 percent of hospital sepsis cases are present on admission.² Whether patients have sepsis upon entering a hospital or contract it while staying there, these statistics illuminate more must be done to recognize the symptoms of sepsis earlier, confirm diagnosis faster and treat the infection more aggressively to save more lives.

According to the Centers for Disease Control and Prevention (CDC), sepsis is the body’s extreme response to an infection. It is life-threatening, and without prompt treatment, often rapidly leads to tissue damage, organ failure and death. Almost any type of infection can trigger sepsis, but those often linked to it occur in the lungs, urinary tract, skin and gut. The most frequently identified pathogens that cause infections that can develop into sepsis include Staphylococcus aureus (staph), Escherichia coli (E. coli) and some types of Streptococcus (strep).³

While anyone can get an infection and almost any infection can lead to sepsis, those at higher risk of infection and sepsis are adults 65 and older, people with chronic medical conditions (especially diabetes, lung disease, cancer and kidney disease), those with weakened immune systems, sepsis survivors and children younger than 1 year old. Signs and symptoms of sepsis can include any one or a combination of symptoms, including confusion or disorientation, shortness of breath, rapid heart rate or low blood pressure, fever, shivering or feeling very cold, extreme pain or discomfort and/or clammy or sweaty skin.³

Fortunately, several organizations are currently tackling this serious infection in hospitals with significant results.

Augusta Health

Augusta Health, a nonprofit hospital located in Virginia’s Shenandoah Valley, prides itself on providing patients with excellent care using state-of-the-art technology. In 2015, Augusta Health established a Sepsis Task Force to find ways to reduce sepsis mortality, which began by researching more efficient ways to detect it. Penny Cooper, DHSc, director of data science and governance at Augusta Health, says, “Since early identification of sepsis remains the greatest barrier to compliance with recommended evidence-based bundles, Augusta Health’s objective was to improve the early identification and treatment of sepsis by developing an automated sepsis screening tool.” 

The tool, which the hospital launched in May 2016 in its emergency department, employs an algorithm that analyzes patient clinical data to determine when a patient shows signs of becoming septic. Based on standard sepsis screening measures, an alert is activated when two or more variables (body temperature, pulse, respiratory rate and white blood cell count) register outside of the normal range and when one or more variables from an additional group (systolic blood pressure and mean arterial pressure check, lactate level or creatinine level) fall outside of the normal range.⁴

Since the sepsis mortality rate rises significantly each hour when treatment is delayed, the algorithm automatically runs every 15 minutes. When the parameters trigger an alert, a secure text is delivered directly to the emergency department charge nurse’s cell phone. If the patient is determined to be septic after an assessment, the charge nurse alerts the entire hospital via an overhead communication. The house supervisor, a phlebotomist and a pharmacist respond to the page by going to the emergency department and assisting with lab work, rapid administration of antibiotics and documentation.⁴

In March 2020, Augusta Health started to work with its ICU staff on a handoff sepsis checklist to ensure all components of sepsis screening are completed in a timely manner. However, because the ICU staff at Augusta Health found it difficult to identify “time zero,” the Sepsis Task Force is revisiting this item to develop a matrix for its ICU staff. If this matrix works well, the hospital will implement it for other units in the patient tower.

In addition to providing continuing education on sepsis compliance to its hospital staff and physicians, Augusta Health has promoted its automated sepsis screening tool to other hospitals in the state for which it has received recognition. The sepsis screening tool was named Health Quality Innovator of the Year for Data-Driven Care in 2018,⁵ and it won the Virginia Patient Safety Summit Performance Improvement award in 2020.

“Our automated sepsis screening tool has significantly reduced Augusta Health’s overall sepsis mortality rates,” says Dr. Cooper. “By subtracting the actual mortality rate from the expected mortality rate, we estimate that 300-plus lives have been saved since the automated sepsis screening tool’s initial implementation in the second quarter of 2016. We expect to continue our automated sepsis screening tool’s use to readily identify the patients with sepsis and begin treatments in a more timely fashion.”

CDC

As part of CDC’s goal to provide health information that protects the nation against expensive and dangerous health threats, the agency has developed a guidance document and campaign to help healthcare professionals tackle sepsis in hospitals.

According to CDC, because there is no confirmatory diagnostic test for sepsis, diagnosis requires clinical judgment based on evidence of infection and organ dysfunction. Therefore, in 2018, CDC developed the Hospital Toolkit for Adult Sepsis Surveillance to help healthcare professionals assess adult sepsis incidence within their facilities. “We have been encouraged to hear that the toolkit is already being used by hospitals to track healthcare facility-level sepsis incidence and outcomes,” says Raymund Dantes, MD, MPH, at Emory Healthcare and medical advisor to CDC’s sepsis team, who helped develop the toolkit. “This shows that ongoing tracking of sepsis using electronic health records is feasible, can be incorporated into healthcare quality improvement initiatives aimed at driving sepsis rates down, and will be used to assess how well local sepsis prevention, early recognition and treatment programs are reducing the devastating impact of sepsis in their communities.”⁶

In addition, CDC’s Get Ahead of Sepsis campaign is a national educational effort that emphasizes the importance of early recognition, timely treatment, reassessment of antibiotic needs and prevention of infections. The infographic for this campaign outlines how healthcare professionals can get ahead of sepsis with four easy steps: 1) Know the signs and symptoms of sepsis; 2) Act fast if you suspect sepsis; 3) Prevent infections by following infection control practices and ensure patients receive recommended vaccines; and 4) Educate patients and their families about preventing infections, keeping cuts clean and covered until healed, managing chronic conditions, recognizing early signs and symptoms of worsening infection and sepsis, and seeking immediate care if sepsis presents.

If healthcare professionals suspect sepsis, they should: 1) Immediately alert the clinician in charge; 2) Start antibiotics as soon as possible in addition to other therapies appropriate for the patient; and 3) Check patient progress frequently.³

HCA Healthcare

Founded in 1968 and based in Nashville, Tenn., HCA Healthcare is one of the nation’s leading providers of healthcare services comprising 2,000 sites of care, including 187 hospitals in 21 states and the United Kingdom. HCA Healthcare is a learning health system that uses the significant data it collects from approximately 35 million annual patient care encounters to inform and improve care for patients. Its national clinical data warehouse, which receives information from electronic health records (EHRs), is the heart of HCA Healthcare’s data ecosystem that has the ability to aggregate and analyze data streams in real time and feed tools that provide actionable information to health professionals.

Using this information, HCA Healthcare’s clinical experts, data scientists and programmers developed Sepsis Prediction and Optimization of Therapy (SPOT), an algorithm-driven, real-time monitoring system that uses predictive analytics to help clinicians “spot” potentially deadly sepsis infections. SPOT was developed over a two-year period from 2017 to 2019, with enterprise-wide rollout completed in 2019. To date, SPOT has been employed to treat 2.5 million patients and has helped save an estimated 8,000 lives in the last five years.

SPOT continuously monitors vital signs, lab results, nursing reports and other data that can inform treatment and recognizes critical data points in patients’ EHRs. It links algorithmic sepsis detection with clinical workflow and quickly alerts care teams to important, often subtle changes in a patient’s condition, so they can take appropriate action. Although SPOT does not make decisions, it does monitor patients in the background and brings vital, accurate and up-to-date information to the healthcare professionals who make decisions.⁷

According to HCA Healthcare, since the symptoms of sepsis are similar to those of many other illnesses, diagnosing it can be very challenging. However, studies have shown with early recognition followed by aggressive treatment, patient survival can increase significantly because sepsis mortality increases 4 percent to 7 percent every hour it goes undetected.⁷

In 2019, HCA Healthcare received the John M. Eisenberg Patient Safety and Quality Award from The Joint Commission and National Quality Forum for SPOT, which can signal potential sepsis six hours earlier than traditional screenings.⁸

Jonathan Perlin, MD, HCA Healthcare’s chief medical officer and president of the Clinical Operations Group, says, “With sepsis, minutes matter, and just as we’ve improved safety in our homes with smoke detectors that ‘sniff out’ possible fire, HCA Healthcare’s SPOT technology now helps detect sepsis earlier, accelerating treatment, improving the care provided to our patients and thereby saving lives.”

Sepsis Alliance

In 2007, Carl Flatley, DDS, MSD, founded Sepsis Alliance in memory of his daughter, Erin Kay Flatley, who died unnecessarily from sepsis in 2002. The organization produces information and educational material to raise public awareness about sepsis and to help healthcare professionals provide information to the public when sepsis strikes.

In 2011, Sepsis Alliance designated September as Sepsis Awareness Month⁹ to bring healthcare professionals and community members together in the fight against it. Sepsis Awareness Month is a national observance in which Sepsis Alliance spends the month working intensely to raise awareness, including hosting community events and its annual Sepsis Heroes gala, and providing toolkits for heath systems and hospitals to spread the word in their facilities. Sepsis Alliance also releases its annual Sepsis Awareness Survey every September. According to the organization, sepsis awareness has increased by 31 percent since 2012, when Sepsis Alliance conducted its first online survey. And since 2003, sepsis awareness has risen from 19 percent to 71 percent.¹⁰

Because adults, especially those over 65, are particularly susceptible to sepsis, Sepsis Alliance launched its “It’s About TIME” campaign in 2019 to make sepsis symptoms more memorable. As a result, when adults potentially have sepsis, they will know when to seek emergency medical care. The acronym TIME stands for T (temperature: higher or lower than normal), I (infection: may have signs and symptoms of an infection), M (mental decline: confused, sleepy, difficult to rise) and E (extremely ill: severe pain, discomfort, shortness of breath). The campaign encourages people who experience a combination of these symptoms to seek urgent medical care, call 911 or go to a hospital with an advocate and ask: “Could it be sepsis?”¹¹

Sepsis Alliance also founded “Erin’s Campaign for Kids” in memory of Erin, which aims to combat the high incidence and mortality rates of sepsis among children. The campaign creates awards and training programs for nurses and other health professionals to help identify and treat sepsis that causes more than 18 child deaths per day or 6,800 child deaths per year.¹²

To coincide with Sepsis Awareness Month, Sepsis Alliance also created Sepsis Heroes in 2011, another annual event that honors patients, doctors, nurses, hospitals and associations making a significant contribution to sepsis awareness and education among the public and healthcare professionals.¹³

Thomas Heymann, president and CEO of Sepsis Alliance, has led the organization’s efforts to launch the Sepsis Alliance Clinical Community, a network that provides sepsis best practice resources and guidance to health professionals in the United States, which is led by a team of expert nursing leaders with critical experience in caring for sepsis patients and developing and implementing sepsis protocols. The community is also led by the Sepsis Alliance Institute, which has awarded more than 18,500 continuing education contract hours to thousands of medical professionals, and Sepsis Alliance Voices, a new platform for national and state advocacy.

According to Heymann, “Sepsis is the number one cause of death in U.S. hospitals and it is a national health crisis. The work Sepsis Alliance does will help save lives by raising awareness of sepsis as a medical emergency.”

Ohio Hospital Association

Established in 1915, the Ohio Hospital Association (OHA) represents the interests of 14 health systems and 240 hospitals across the state. Hospitals include acute care facilities, long-term acute care facilities and those specializing in psychiatry, rehabilitation, specialty surgery and pediatrics. 

In 2015, to celebrate its 100th birthday, OHA decided to form the Institute for Health Innovation to acknowledge this milestone, choosing sepsis as one area that Ohio hospitals desperately needed to focus on. The institute developed the Statewide Sepsis Initiative (SSI), which starts with participating hospitals performing a gap analysis to evaluate their individual performance with early recognition and early intervention and identify opportunities for improvement. Key tenets of SSI are to: 1) Collect, analyze, monitor and report sepsis mortality-related data; 2) Design and provide pertinent monthly evidence-based continuing education programs addressing current trends in sepsis care, leveraging regional, state and national subject matter experts; 3) Collaborate with provider groups and other state and national quality initiatives; 4) Assess and address healthcare provider needs related to the timeliness and accuracy of diagnosing sepsis; and 5) Target efforts toward early and appropriate treatment of sepsis not present at time of admission.

OHA staff, including nurses and physicians, work with hospital staff and clinicians who lead the focus on sepsis. Educational sessions are also conducted virtually via teleconference and webinars. So far, 125 hospitals are participating in the five-year program, and it is hoped that eventually the majority of the state’s more than 200 hospitals will participate.¹⁴

One of the goals in OHA’s 2019-2021 strategic plan is for SSI to continue its efforts to reduce sepsis mortality to a rate of 14.9 percent by the end of 2021. In the past year, OHA says more than 45,000 sepsis encounters have occurred in Ohio hospitals and, of those, it estimates 5,480 lives were saved from sepsis due to SSI.

In September 2020, the Sepsis Alliance named OHA as a Sepsis Hero in recognition for its work in reducing sepsis mortality by raising awareness and improving management throughout Ohio.¹⁵ And, in support of Sepsis Alliance’s Sepsis Awareness Month, OHA has been working with the Ohio governor’s office for the past five years to officially proclaim September as Sepsis Awareness Month.

John Palmer, director of media and public relations at OHA, says, “Through ongoing focused efforts, the OHA’s Statewide Sepsis Initiative will continue its work toward further decreasing sepsis mortality through early recognition and through early, appropriate intervention. Increasing community awareness, providing continuing education programming, partnering with Sepsis Alliance and monitoring our progression are examples of strategies that we will continue to utilize.”

Awareness and Tools Reduce Incidence and Death

It is hoped that with continued sepsis awareness and education, together with new protocols and state-of-the-art tools, healthcare professionals will continue to help patients lower their risk and incidence of sepsis, and most importantly, greatly reduce the number of deaths caused by sepsis every year in the United States.