The cost of treating patients who develop sepsis in the hospital rose by 20% in just three years, with hospitals spending $1.5 billion more last year than in 2015, according to a new analysis.
The report, published Thursday by Premier, found that although the number of patients who developed sepsis during their hospital stay declined by 15% from 2015 to 2018, those patients were more likely to get septic shock—the most severe form of sepsis—and therefore cost more to treat.
Septic shock "is quite a bit more costly because of the level of care needed for those patients," said Dr. Madeleine Biondolillo, vice president of quality innovation at Premier.
Premier found that the average cost per case for hospital-associated sepsis jumped from about $58,000 in October 2015 to about $70,000 in September 2018. At the same time, patients who developed sepsis in the hospital were 10% more likely to have septic shock than those with sepsis upon admission. Septic shock is the last stage of sepsis and the most deadly.
Biondolillo said septic shock is probably more common among patients already in the hospital because they are sicker. Patients with weakened immune systems and trauma are at risk for sepsis.
Another reason could be that efforts around sepsis have been more focused on ways to identify and treat sepsis upon admission to the emergency department. Less attention has been paid to continuously monitoring the condition in inpatient units, Biondolillo said. This could allow sepsis to go undetected and escalate to septic shock.
"The answer is if it works great in the ED, do it everywhere," she said.
Efforts around sepsis could be more focused in the ED because the vast majority of sepsis patients—about 92.5%—already have the condition when admitted to the hospital.
It also costs less for a hospital to treat sepsis upon admission, at about $22,000 per case on average compared to $70,000 for hospital-associated sepsis, according to the Premier analysis. Detecting sepsis upon admission likely means the patients are in the beginning stages of the illness when it's easier to reverse, Biondolillo said.
Time is of the essence when it comes to sepsis. Once patients show clear sepsis warning signs like organ failure, it becomes difficult to reverse the condition's course and the mortality rate increases. An estimated 250,000 people die from sepsis each year in the U.S.
As a result, the CMS requires hospitals to comply with a sepsis bundle, which involves hospitals initiating treatment within three- and six-hour time frames. The national average compliance rate for the bundle is 51%, according to the most recent data on Hospital Compare.
Premier's analysis included data from 871 hospitals representing 1.7 million cases.