Hospitals need to redouble their efforts in fight against deadly, costly sepsis cases

Sepsis remains one the most challenging and lethal illnesses in hospitals across the country. It's hard to diagnose, mimics other conditions and is complicated to treat.

Every year, sepsis strikes more than 1 million Americans and kills almost a quarter of those affected. It is also the most expensive medical illness in hospitals, with an annual cost of more than $16 billion.

The mortality rate of severe sepsis or septic shock is approximately 40%. Patients with sepsis have longer hospitalization stays and higher readmission rates than patients with other conditions. Those who survive may face devastating consequences, including permanent organ damage, cognitive impairment and physical disability.

Sepsis has remained a stubborn adversary—treatment guidelines are complex and can include dozens of steps—but hospitals have an opportunity to save lives and improve outcomes with a forward-thinking systemic approach anchored by a multidisciplinary team, technology that enables collaboration, actionable data and ongoing education.

Even with the high prevalence of sepsis, patients and their families don't know much, if anything, about the symptoms, and the diagnosis requires combining data from an exam, medical history and lab work.

It's important that we increase the level of education and raise sepsis awareness among patients and their families similar to how we've taught them to recognize heart attack and stroke. Also, we have to improve training of front-line clinical staff around recognizing sepsis, its physiology and the myriad ways it silently presents.

To make strides against sepsis nationwide, all hospitals and health systems need to create care processes and order sets that are easy to use, share best practices and enhance data collection and analysis to track clinical and financial outcomes.

We can improve outcomes by using order sets that segment the sepsis population based on low-, medium- and high-risk classifications to decrease variation and increase compliance of evidence-based treatment goals; establishing a 24/7 sepsis nurse function to ensure protocol is consistently followed; monitoring and analyzing outcomes and implementing a performance-improvement process to ensure sepsis care is continually refined.

Unfortunately, there is continued inconsistency across hospitals when it comes to the sepsis protocols. Little has been done in the industry to identify a specific process that drives early identification and treatment of this complication. Given the sobering impact of sepsis, St. Joseph Hoag Health, an integrated system in Southern California, has made prevention an organizational—and regional—priority. Each year, we treat about 8,000 sepsis patients at an annual cost of $130 million. We know that many of those cases are preventable.

Our team has developed roles and workflows for sepsis coordinators, sepsis checklists and caregiver rounding tools. To increase recognition of sepsis cases, we developed our own screening tool, incorporating specific markers to more accurately determine the presence of sepsis and thereby prevent unnecessary tests and therapies. Additional criteria were established to better support designation of ongoing patient care.

Monthly sepsis clinical measures are available via a nearly real-time dashboard based on a simplified Sepsis Early Detection Algorithm we customized to help clinicians monitor the progress. Dedicated sepsis nurses respond to “code sepsis” calls, coordinate care and follow patients through their first 24 hours of care. We also created a digital platform that allows us to capture the progress of sepsis treatment as it occurs. We are combining these efforts with clinical operational data and financial data to help us understand the drivers of outcome variation.

In January, the mortality rate attributed to sepsis was 8.89% at our hospitals, down from 15.28% in January 2015. Data show the effort has saved 168 lives since last July.

Clinicians and healthcare executives know we'll never eradicate sepsis, but we can significantly reduce its impact. More patients will survive, survivors will spend less time in hospital beds, hospitals will spend less on their care, and we'll have healthier communities.