This article originally appeared on HFMA (https://www.hfma.org/Content.aspx?id=49856) on Aug. 24, 2016.
HOSPITAL LEADERS ALREADY HAD BEGUN SPREADING SEPSIS-CONTROL EFFORTS INTO THEIR COMMUNITIES BEFORE THIS WEEK’S CALL BY THE CDC FOR THEM TO DO SO.
Aug. 24—Amid stepped-up hospital efforts to identify and treat sepsis—as well as rising costs from the condition—the Centers for Disease Control and Prevention (CDC) is urging a wider campaign.
In nearly 80 percent of cases, sepsis, which is caused by the body’s overwhelming and life-threatening response to an infection, begins outside of the hospital, according to the CDC. That means more prevention, identification, and treatment needs to happen in the community.
"When sepsis occurs, it should be treated as a medical emergency," Tom Frieden, MD, MPH, director of the CDC, said in a release. “Doctors and nurses can prevent sepsis and also the devastating effects of sepsis, and patients and families can watch for sepsis and ask, ‘Could this be sepsis?’”
A CDC report also provided new data that could help hospitals and other providers with their efforts to identify a condition that may not always be obvious. For instance, about 7 in 10 patients with sepsis had used healthcare services recently or had chronic diseases that required frequent medical care, according to the CDC.
According to the CDC report, infections of the lung, urinary tract, skin, and gut most often led to sepsis. In most cases, the pathogen that caused the infection leading to sepsis was not identified. When identified, the most common pathogens leading to sepsis were Staphylococcus aureus, Escherichia coli (E. coli), and some types of Streptococcus.
The CDC urged healthcare providers, patients, and their families to work as teams to prevent sepsis by protecting patients from infections that can lead to sepsis and recognizing sepsis early.
Some hospitals have taken the lead in pushing sepsis detection and early treatment out to the broader community. For instance, several of the 350 hospitals that are part of Premier’sQUEST quality improvement collaborative have worked with local emergency medical service (EMS) units to detect and begin treatment for sepsis among patients who call for emergency assistance.
“If you suspect that they might be in early sepsis, quick initiation of therapy is critical,” Gina Pugliese, RN, vice president of the Safety Institute at Premier, said in an interview. “So if you can work with the emergency medical folks, you are saving an hour during transport time by giving them some kind of care on the way to the hospital.”
The CDC recommended this week that antibiotics and other recommended medical care begin immediately if sepsis is suspected.
Steven Simpson, MD, acting director of the Division of Pulmonary and Critical Care Medicine at the University of Kansas Medical Center, is working to have sepsis added as an official time-critical diagnosis for Kansas EMS units.
“We’re trying to get sepsis added to that list officially so that is how our EMS providers treat it,” Simpson said in an interview. “If you do a good job picking it up on the front end then you save costs for sure.”
Ohio hospitals are about to begin a sepsis education outreach initiative to first responders, caregivers, and long-term care providers as the latest stage in a multiyear effort to reduce sepsis rates in the state.
“By the time they come to the hospital, timing is everything because they’ve come to a severe state where sepsis has reached the point of organ shutdown and tissue damage,” John Palmer, a spokesman for the Ohio Hospital Association (OHA), said in an interview. “So we’re working with our hospitals, nursing homes, EMS providers, and all of the touchpoints in the community to pull together an earlier response.”
That initiative echoes the CDC’s call this week for providers to educate patients and family members on “the need to prevent infections, manage chronic conditions, and, if an infection is not improving, promptly seek care.”
Such outside efforts come on top of increasingly common internal initiatives at hospitals, where sepsis has become the costliest condition treated, according to a June report by the Agency for Health Research and Quality (AHRQ).
Sepsis treatments cost $23.7 billion, or 6.2 percent of the aggregate costs for all hospitalizations, in 2013—the latest year for which data are available. The total increased from $20.3 billion in 2011, when sepsis represented 5.2 percent of national costs, according to a previous report.
Further complicating the situation was that septicemia ranked as the second-leading cause of hospital readmissions, according to a previous AHRQ report. The condition drove 5 percent of all Medicare readmissions.
The implications of hospitals’ sepsis cost increases were underscored in an AHRQ sepsistoolkit, which noted that up to 27 percent of patients admitted to intensive care units have severe sepsis, and mortality rates for the condition range from 20 percent to more than 50 percent.
Much of the documented cost increase was likely driven by greater detection efforts, which stem in part from the 2015 start of sepsis measurement requirements by the Centers for Medicare & Medicaid Services.
“More reporting is uncovering the fact that we are, as a nation, mediocre at best at recognizing this entity,” said Simpson, who is also a member of the board of directors of the Sepsis Alliance.
Despite the worsening numbers, several individual, regional, and state initiatives have made progress on sepsis. For instance, two sets of sepsis interventions implemented at about 100 Ohio hospitals in 2015 were credited with helping to cut sepsis mortality by 8 percent in the first nine months, according to the OHA. Additionally, hospitals participating in Premier’s QUEST initiative have cut sepsis mortality by 22 percent over the last six years.
Simpson noted the main obstacles keeping more hospitals from effectively combatting sepsis include a lack of knowledge by nonemergency providers and the lack of a quick detection tool.
Proven sepsis tools for hospitals include adding the signs and symptoms to their electronic health record, along with adding the treatment protocol to ensure it is implemented consistently, Pugliese said. Other hospitals have found success with the use of color-coded sepsis protocol charts and sepsis clocks—which show what treatments are needed within certain time frames—mounted on the walls of the emergency department.
With respect to sepsis detection and treatment efforts, Pugliese said, “You get the big bang from putting all of the elements into place.”