“Sepsis is the body’s overwhelming response to an infection. It can occur in virtually anyone with an infection, though it’s more likely to appear among elderly individuals and those who have undergone surgery. While health care providers are broadly aware of the condition and its symptoms, it can be difficult to identify early.
Sepsis can start off with a fever and increased heart rate, but can quickly become more serious as it causes difficulty breathing, changes in skin color, and organ failure. The initial treatment for sepsis, antibiotics and intravenous fluids, is deceptively simple and widely accepted among health professionals. The big treatment challenge is time, because with every hour that passes during which the patient isn’t treated, the prognosis worsens significantly.
To help ensure timely, consistent, and high-quality care for sepsis patients, the Centers for Medicare and Medicaid Services adopted in 2015 the Sepsis National Hospital Inpatient Quality Measure (SEP-1) that had been developed by the National Quality Forum. This metric assesses hospitals’ timely treatment of sepsis, which costs more than $27 billion annually. Going a step further, the Centers for Medicare and Medicaid Services on Wednesday began publishing sepsis treatment statistics for all hospitals across the country. This is the first time that this information is being made publicly available.
To find your hospital’s score, visit Medicare’s Hospital Compare website. Type in your ZIP code, then the hospital’s name. On the hospital’s page, click the “Timely & effective care” tab and then click the “Sepsis care” drop-down menu. You can then see the hospital’s score and compare it to state and national averages.
A high score shows that a hospital has been following sepsis treatment protocols and that, when patients develop sepsis, they are generally treated properly. A low score indicates poor sepsis care.
Hospital Compare currently includes SEP-1 scores for the first nine months of 2017. The first full year of data will follow in October…. (A)
“More than half of hospitals on average fail to comply with the CMS’ sepsis treatment requirements, new data from the agency reveals.
The data, publicly released Wednesday on Hospital Compare for the first time, show that the national average compliance rate for the CMS’ sepsis treatment measure was 49%. But patient safety experts say the generally low compliance rate for the measure doesn’t necessarily mean sepsis treatment is poor at hospitals. The measure is a process measure, so it doesn’t directly reflect outcomes for patients with sepsis. Additionally, clinical nuance and trouble reporting the measure must be taken into account when looking at the data.
The measure—called the Severe Sepsis and Septic Shock Early Management Bundle—was adopted by the CMS in July 2015 to improve hospitals’ identification and treatment of sepsis, a serious and life-threatening condition. More than 200,000 people die each year from sepsis, according to the agency. A study last year also found the mortality rate from the condition has worsened in recent years.
The measure requires hospitals to follow multiple, time-sensitive steps to comply. Physicians and researchers say that early dedication and intervention is critical to prevent death from sepsis…
“What CMS has done with sepsis has elevated everyone’s game and made us all aware of the importance of compliance but I take these numbers with a grain of salt,” he said.
The CMS data set includes performance of 3,005 hospitals for the first nine months of 2017.” (B)
Not all clinicians agree…
“Guidelines that go beyond guidance and move to regimented, time-based prescriptions of care must be based on unassailable evidence. Even then, the clinician’s assessment of the individual patient should allow a diversion from the guideline directed care.
The current iteration of the Surviving Sepsis Campaign Guidelines (2018) fails on all counts:
The recommendations are based on low to moderate quality evidence. Even this level of evidence lumps into one group various severities of illness.
Despite this, the recommendations are made at a Strong level without conditionals
No consideration is made for the judgment of clinician as to whether the individual patient in front of them will be helped or harmed by the recommendations
No consideration has been made for the downstream effects these guidelines will have on other non-septic patients being cared for simultaneously.” (C)
More than one in 10 children hospitalized with sepsis die, but when a series of clinical treatments and tests is completed within an hour of its detection, the chances of survival increase considerably, according to a new analysis led by the University of Pittsburgh School of Medicine.
The results, published today in the Journal of the American Medical Association, support an initially controversial New York mandate established after 12-year-old Rory Staunton died from undiagnosed sepsis in 2012 following an infection from a scrape. These results will likely encourage the mandate’s expansion to other states…
Rory’s Regulations require New York hospitals to follow protocols regarding sepsis treatment and submit data on compliance and outcomes. The hospitals can tailor how they implement the protocols, but must include a blood culture to test for infection, and administration of antibiotics and fluids within an hour to any child suspected of sepsis.
Seymour and his team analyzed the outcomes of 1,179 children with sepsis reported at 54 New York hospitals. The children had an average age of just over 7 years, and 44.5 percent were healthy before developing sepsis. A total of 139 patients died.
Completion of the sepsis protocol within one hour decreased the odds of death by 40 percent. When only parts of the protocol were completed within an hour – for example, giving fluids but not testing for infection or giving antibiotics – the patients did not fare better. The finding held only if the entire protocol was completed in an hour.
“It’s clear that completing the entire sepsis protocol within an hour is associated with lower mortality,” said lead author Idris V.R. Evans, M.D., assistant professor in Pitt’s Department of Critical Care Medicine. “But the mechanism of benefit still requires more study. Does each element of the protocol contribute to specific biologic or physiologic changes that, when combined, improve outcomes? Or is it that completion within an hour may simply be an indication of greater awareness by doctors and nurses caring for the child? Or could it be something else entirely?”
The researchers note that testing the sepsis protocol in a future randomized clinical trial will be very difficult. Such work would require leaving off some protocol elements for some septic children but not others in a random fashion – a design which would not currently align with the standard of care. But if more states adopt rules and regulations similar to New York’s, and also mandate data reporting, future work could expand on these results.” (D)
“The prognosis of patients with sepsis is related to the severity or stage of sepsis as well as to the underlying health status of the patient. For example, patients with sepsis and no ongoing sign of organ failure at the time of diagnosis have about a 15%-30% chance of death. Patients with severe sepsis or septic shock have a mortality (death) rate of about 40%-60%, with the elderly having the highest mortality rates. Newborns and pediatric patients with sepsis have about a 9%-36% mortality rate.” (E)
“Patients today tend to have options when seeking hospital care. Those aware of the dangers of sepsis may well look for hospitals with more favorable sepsis ratings. This isn’t a Yelp review or blog post; it’s an official report from the Centers for Medicare and Medicaid Services. Since hospitals no longer have the option to conceal this information, it pushes the issues of transparency and accountability to the surface, which are absolute necessities to drive change.
Hospitals are working to combat sepsis: employing special training to educate staff on the warning signs of sepsis; mandating the use of protocols; and deploying electronic surveillance and alerting systems. Many such systems frequently fire false alerts. Over time, staff members tend to ignore these alerts, due to what is known as alert fatigue. A highly accurate and effective alerting system can be a game-changer in saving lives.
Institutions need to look closely at their sepsis performance and it will be a sobering moment for some. But this new trove of data has the potential to be historic in combating the deadliest condition in U.S. hospitals. July 2018 could be the dawn of a new era of sepsis treatment, one in which more patients will be as fortunate as the young hunter I cared for and make full recoveries from this deadly and fast-moving condition.” (A)
(A) Hospital Compare lifts the veil on sepsis care. Check your hospital’s score, by Steve Claypool, https://www.statnews.com/2018/07/26/hospital-compare-lifts-veil-on-sepsis/
(B) Just 49% of hospitals follow CMS’ sepsis treatment protocols, By Maria Castellucci, https://www.knoxnews.com/story/news/health/2018/07/27/sepsis-treatment-how-do-east-tennessee-hospitals-score/844117002/
(C) Surviving Sepsis Campaign: Retract the SSC 2018 Guidelines, by: Emcrit P, https://www.thepetitionsite.com/772/830/097/surviving-sepsis-campaign-sccm-esicm/
(D) Pediatric sepsis care within an hour increases chances of survival, shows study, https://www.news-medical.net/news/20180725/Pediatric-sepsis-care-within-an-hour-increases-chances-of-survival-shows-study.aspx
(E) Sepsis (Blood Poisoning), by Charles Patrick Davis, https://www.medicinenet.com/sepsis/article.htm#what_causes_sepsis
Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.