Sepsis has a substantial impact on U.S. hospitals. How can healthcare providers better safeguard their patients?
February 2024 – The Journal of Healthcare Contracting
The body’s extreme response to infection, including sepsis, are life-threatening medical emergencies. Yet, despite the seriousness of sepsis, large numbers of patients develop it within hospitals. At least 1.7 million adults in America develop a sepsis infection each year, and nearly 350,000 adults die from sepsis yearly, according to the Centers for Disease Control and Prevention (CDC). Sepsis occurs when almost any infection that a patient already has (such as influenza, COVID-19, pneumonia, etc.) triggers a further reaction in the body.
Sepsis is not a contagious disease and can’t be transmitted to other patients. Instead, infections that lead to sepsis often start in the lungs, urinary and gastrointestinal tract, and skin, according to the CDC. Symptoms of sepsis include a heightened high heart rate, confusion, extreme pain and discomfort, fever, shortness of breath, clammy skin, and more.
Anyone can develop sepsis, but risk factors such as being 65 or older, being a child under the age of one, having a weakened immune system, having chronic medical conditions including diabetes or kidney disease, or having recently been hospitalized, make the chances of developing it much higher according to the World Health Organization (WHO).
Sepsis within U.S. hospitals
According to the CDC, one in three people that die in the hospital had sepsis during the hospitalization. Many infections can resolve on their own, but for some individuals with a severe infection, that is not the case, and they go on to develop sepsis.
“When a patient develops a worsening infection, whether the initial infection is viral or bacterial, or starts in the skin, lung, urinary tract, or anywhere else, the patient may continue growing sicker, and ultimately develop sepsis,” said Akin Demehin, Senior Director of Quality and Patient Safety, American Hospital Association.
Sepsis acquired in healthcare settings is a frequent adverse event during care delivery, affecting hundreds of millions of patients worldwide every year, according to the WHO. Sepsis is also a burden on the U.S. healthcare system, as the condition often leads to hospital readmissions and longer hospital stays, according to statistical brief (#168) from The Healthcare Cost and Utilization Project1.
“In addition to its impact on patients, sepsis is an important health focus because the condition is also a burden to healthcare systems,” said Angela Craig, Medical Science Liaison and Clinical Nurse Specialist in Critical Care, Baxter. “Sepsis is the number one cause of hospital readmissions2, sepsis patients usually have a longer hospital stay3, and sepsis is the most expensive reason for hospitalization, costing more than $53 billion annually in the U.S.4, 5”
CDC’s sepsis response
The CDC launched the Hospital Sepsis Core Elements program to support U.S. hospitals in ensuring that effective resources are in place to identify sepsis quickly and accurately. The resource allows staff to identify routine practices and leadership structures that assist in managing sepsis rates in hospitals. The CDC recommends that hospitals integrate a multi-disciplinary system within their sepsis programs to monitor and improve the outcomes of patients with sepsis.
According to the CDC, the key elements of the sepsis control program include leadership commitment, which dedicates the necessary human, financial, and IT resources toward sepsis management; accountability, or appointing a leader responsible for setting program goals; multi-professional expertise, which engages key partners in the organization; action, which implements processes to identify, manage, and help patients recover from sepsis.
The next steps of the program include monitoring sepsis to reduce disease incidence. This includes close tracking, which measures sepsis epidemiology, progress toward goals; reporting, which provides usable information on sepsis treatment and outcomes to relative partners; and finally, education, which provides crucial sepsis information to healthcare professionals during onboarding and annually.
“The CDC’s Hospital Sepsis Program Core Elements effort is a resource that helps providers identify sepsis more quickly, and provides tools to implement, monitor, and help optimize their sepsis programs,” said Craig.
The CDC framework is beneficial because hospital systems can use it as a guide, tailoring the program in a way that works best for their healthcare procedures. Hospital-specific programs may focus on sepsis only, or they could be part of a broader initiative that addresses multiple areas of quality improvement throughout the hospital. The program’s goals may be specific to a single hospital or span entire healthcare systems.
These core elements guide hospitals in structuring a sepsis program that rapidly identifies effective care for patients with sepsis. The CDC Sepsis Core Elements are designed to guide medical leaders in organizing staff and help with increasing sepsis-related survival rates.
“Sepsis is a complex disease and there is no one-size-fits-all approach to preventing, identifying, treating, and measuring it. That is one reason why the CDC’s new Sepsis Core Elements offer a broad, evidence-based foundation of practices. From this scaffolding, hospitals and healthcare professionals can build the program they need to best support their own, unique communities,” said Demehin.
For hospitals that are just beginning their sepsis program with limited resources, they should first identify a sepsis program leader or co-leader, secure support from hospital leadership, conduct a needs analysis to order sets and supplies, be aware of any regulations, and obtain necessary data to begin establishing the initial goals for a successful sepsis program.
Physicians play a role
For hospital patients that have been diagnosed with sepsis, it is important to recognize that physicians and healthcare providers play a critical role in monitoring fluids and treatment as patients transition between care. Physicians should act quickly and know how to identify the signs of sepsis, as it can make a significant difference in the survival of a patient.
“One essential step in sepsis monitoring is to bring together relevant experts inside a hospital to provide a multi-disciplinary approach to the rapid identification and treatment of sepsis. Leadership commitment to supporting that team’s work also helps encourage implementation of the standard processes and protocols used to rapidly identify and treat patients at risk for sepsis,” said Demehin.
Following the CDC’s guidelines, and establishing a clear leader in infection prevention efforts, can assist a hospital in properly managing each patient’s sepsis infection.
“Patients hospitalized with sepsis often receive IV fluids, and proper fluid management may improve a patient’s clinical outcomes. Increasing awareness among healthcare teams of early detection of the condition and appropriate fluid management tools that provide accurate and precise data such as the Starling Fluid Management Monitoring System can help make an important impact,” said Craig.
Future of sepsis care
The overall impact of sepsis in hospitals became more evident during the hospital admittance surges during the COVID-19 pandemic, according to a study titled “Sepsis: New Challenges and Future Perspectives for an Evolving Disease” from the National Library of Medicine.
A notable challenge in treating sepsis is the variety of reactions to treatment experienced on a patient-by-patient basis. Sepsis can be a full-body reaction to a previous illness, requiring external support such as ventilators, dialysis, maintenance of blood pressure, and more, according to the Society of Critical Care and Medicine. Many patients who do survive experience ongoing complications after a sepsis infection, such as physical and cognitive issues that linger.
“Everything we know about sepsis tells us that early diagnosis and appropriate rapid treatment with antibiotics saves lives. But sepsis may present very differently in different populations. For example, the early signs of sepsis in a premature newborn can look very different than those of a trauma patient coming out of surgery or an elderly patient being transferred from a nursing home,” said Demehin. “Moreover, for people struggling to cope with multiple chronic conditions, the early symptoms of sepsis can mimic those of any number of other conditions. As a result, hospitals frequently implement programs that focus on the rapid identification and treatment of sepsis.”
Many studies are currently underway to find more effective methods to identify patients who have sepsis, how the disease impacts each individual, and possible biomarkers that could identify the disease, according to the Society of Critical Care Medicine.
Said Craig, “At Baxter, our mission is to save and sustain lives. For sepsis, that comes to life by helping to bring awareness to the condition, early detection, and treatment including the critical role that fluid management can play.”
“We are fortunate to live in an age of technological transformation with real-time analytics, machine learning and natural language processing that are helpful tools for clinicians in predicting, identifying and responding to sepsis. Artificial intelligence can be used in hospital settings to review digital records in real-time to help doctors, nurses and advanced practice providers identify patients at risk of sepsis even earlier,” said Demehin. “We must continue to resource these kinds of innovative approaches as we strive to stamp out sepsis.”
Sources:
1 https://www.ncbi.nlm.nih.gov/books/NBK179289/
2 Chang DW, Tseng CH, Shapiro MF. Rehospitalizations following sepsis: common and costly. Crit Care Med. 2015;43(10):2085-2093.
3 Latham HE, Bengtson CD, Satterwhite L, et al. Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes. J Crit Care. 2017;42:42-46
4 Buchman, T. G., Simpson, S. Q., Sciarretta, K. L., Finne, K. P., Sowers, N., Collier, M., … & Wax, M. (2020b). Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018. Critical Care Medicine, 48(3), 302.
5 Torio, C. M., & Moore, B. J. (2016). National inpatient hospital costs: the most expensive conditions by payer, 2013: statistical brief# 204. Healthcare cost and utilization project (HCUP) statistical briefs, 2006-2016.