Sepsis – Simple steps in ER saves lives

This post was authored by Sharon Stabile and posted to The Eye Opener on October 7th, 2010.

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Following summer headlines citing extensive hospital deficiencies in screening a fatal illness known as sepsis, there is some good news out of Kaiser Permanente this week.

Sepsis as defined by Wikipedia as a serious medical condition affecting the whole body. As we know, it can even be fatal. Sepsis is caused when a harmful infectious organism invades the body. Invasion can occur through the blood, urine, lungs, skin, or body tissue. The body reacts with an inflammatory response that is characterized by fever or low body temperature, low blood pressure, and an increasing high white blood cell count.  In earlier times the condition was commonly called “blood poisoning”.

As the patient becomes sicker, the body becomes overwhelmed by an acid called lactate acid. It is formed as a result of lowered oxygen to organs and tissue resulting in a condition known as lactic acidosis. As the condition progresses, the body eventually can not overcome the acidosis and low tissue oxygen perfusion. Death ensues often despite aggressive medical treatment.

Kaiser reported 17 participating hospitals in Northern California began using a 6-step diagnostic and treatment tool known as a “sepsis bundle” in 2008 to rapidly diagnose and treat sepsis. Using this new tool and computerized medical records, Kaiser found the patient death rate improved significantly from 25% to 11%, the patients’ hospital stays were 3 days shorter, and $36 million was saved.

However, just the day before Kaiser released their data, another article in FierceHealthcare – daily news for healthcare executives - listed infections add an average 19 days to a hospital stay with a cost per patient of $43,000. This study was published by the Agency for Healthcare Research and Quality who concluded that 12% of all infections were classified as sepsis. Two months ago, Fierce Healthcare reported excerpts from new research published in the Archives of Surgery by a surgeon named Laura Moore practicing at Houston’s Methodist Hospital. Dr. Moore performed a retrospective review of 364,000 general surgery patients registered in the American College Of  Surgeons National Surgical Quality Improvement Database. Sepsis occurred in 2.3% totaling 8,372 patients.  She also wrote mortality from sepsis has doubled in the last 20 years. Sepsis is the leading cause of death in general surgery ICU’s.

In December 2008, the European Society of Critical Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine launched the Surviving Sepsis Campaign. Sepsis is estimated to kill 1,400 people worldwide each day. Mortality rates from severe sepsis are rated as high as lung, breast, and colon cancer. The campaign wrote severe sepsis is expected to grow at 1.5 % annually with an additional 1 million cases per year in the USA by 2020. The campaign sited the cause for this is due to the aging population and increasing invasive medical procedures. HIV and cancer rates are increasing, which will also impact severe sepsis rates.

Sepsis varies greatly in its progression and symptoms seen in each patient. This makes early diagnosis and treatment challenging for even the best ICU physicians. Symptoms such as fever, rapid pulse rate, and respiratory difficulty are commonly seen in a host of other medical conditions. Obtaining an accurate diagnosis can take precious time. In an effort to improve the diagnosis and survival rates, the campaign challenged to USA hospitals to adopt and implement a “sepsis bundle” program and begin reducing mortality by 25% over the next 5 years.

So what is a sepsis bundle? The Surviving Sepsis Campaign chose medical therapies called “elements” designed to give physicians worldwide a framework to standardize sepsis practices. Their specific intent was to reduce the chaotic approaches seen in many clinical settings. The campaign founders consolidated world medical care data and practices that had shown clear positive impact on outcomes. They challenged critical care physicians to choose a grouping of these elements based on their patient population. Next,  physicians were to apply their individualized “sepsis treatment bundle” and  study the outcomes by using the campaign’s measurement database. By choosing to delete an element(s), the hospital would be classified as non-compliant and their performance data would likely show poorer outcomes.

In the sepsis resuscitation bundle, there were 5 critical elements. In the sepsis management bundle there were 4 elements.  So neither bundle is too complicated or intricate to put into medical practice. Now two years later, those early hospitals that accepted the challenge and implemented a sepsis bundle program are publishing their success data. Another fine example was published by Barry Evans, RN, MSN, Adult Critical Care Data Coordinator at the University of Rochester/Strong Health.

Kudos to Kaiser Permanente California, Strong Health, and all the other critical care services who accepted the 2008 challenge for US patients and are making it happen. Can’t wait to see the campaign’s worldwide end data in 2013!

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