Rapid diagnosis and treatment of sepsis saves lives.
In recent years, HCA Healthcare and OhioHealth have been able to reduce sepsis mortality significantly.
September is Sepsis Awareness Month. Sepsis and the body's response to the infection is one of the deadliest medical syndromes in the United States, according to the Centers for Disease Control and Prevention. About 1.7 million adult Americans develop sepsis annually and the condition claims about 270,000 lives each year. About one-third of patients who die in hospitals succumb to sepsis.
Decision support tool
HCA Healthcare has developed a computer-based decision support tool called Sepsis Prediction and Optimization of Therapy (SPOT), and it can detect sepsis 18 hours earlier than the best clinicians, says Jonathan Perlin, MD, PhD, president of clinical services and chief medical officer at the Nashville-based health system.
"This is the future. Military fighter planes can't fly without decision support. Healthcare is equally complex. To think that we can manage all the variables without assistive technology is inconsistent with how we think about high-reliability endeavors like aviation and healthcare," he says.
HCA Healthcare started adopting elements of the Surviving Sepsis Campaign in 2013. From 2013 to 2017, sepsis mortality at the health system's hospitals fell 39%. HCA Healthcare launched the SPOT initiative in 2018. From 2017 to 2018, sepsis mortality at the health system's hospitals dropped nearly 23%.
SPOT features an algorithm embedded in HCA Healthcare's electronic health record that was built with Red Hat open source software. To indicate the onset of sepsis, the SPOT algorithm combines factors such as patient demographics data and medical history with continuous monitoring for signs and symptoms of sepsis as well as key elements of clinical care:
- Body temperature
- Blood pressure
- Heart rate
- Platelet count
- Laboratory tests
- Patient transfers such as moves to an ICU
"The SPOT algorithm surveils 24 hours a day, seven days a week to look for the signs and symptoms of sepsis. When those signs are found, they are teed up and presented to the caregivers," Perlin says.
When the algorithm detects a likely case of sepsis, SPOT initiates an alert similar to a heart attack or stroke code that prompts clinical care teams to take action. Caregivers who receive the alerts include telemetry units, nurse leaders, sepsis code teams, and rapid response teams.
An essential component of the SPOT initiative is the algorithm's diagnostic accuracy, Perlin says.
"We were able to train the algorithm to be more than 100% sensitive—we picked up cases of sepsis that the care providers did not see, and our rate of false positives was half that of care providers. So, the specificity was twice as good as clinicians. It not only improved care but also the efficiency of doctors and nurses," he says.
At OhioHealth, a systemwide initiative involving physicians, nurses, laboratory operations, and pharmacists has helped the Columbus, Ohio-based health system reduce its sepsis mortality rate.
Starting in July 2015, OhioHealth reduced sepsis mortality by educating staff members, utilizing a rapid diagnostic test, reducing the medication response time from hospital-based pharmacists, and creating a clinical culture that tolerates false diagnosis.
The effort required engaging thousands of health system workers about sepsis and highlighting an opportunity for care improvement, says James M. O'Brien Jr., MD, MSc, system vice president for operations and population health. "A big piece has been making the case that this work is important to us as an organization by looking at the underlying data of what our baseline mortality rate was and how many people it was affecting across our health system."
When OhioHealth launched the sepsis effort in 2015, the sepsis mortality rate was 24.3%. In 2018, mortality in sepsis patients was 20%.
Rapid sepsis testing reduced the laboratory time required to diagnose sepsis and narrow down the best antibiotic treatment from a day or more to a couple of hours, O'Brien says.
The previous generation of sepsis tests required a lengthy two-step process. First, a blood culture test would determine whether a patient was positive for sepsis, then the blood culture would be challenged with multiple antibiotics to see which antibiotic would be best for treating the patient.
With the rapid testing technology, once a blood culture tests positive for sepsis, molecular testing quickly narrows down the best antibiotic to treat the patient.
Once an OhioHealth clinician has prescribed an antibiotic, pharmacists are expected to have the medication at the bedside in less than an hour, O'Brien says. "In pharmacy, you need engagement with the medication safety pharmacist and the antibiotic stewardship pharmacist. They are the folks who tend to be most in tune with our pattern of resistance to antibiotics and what is appropriate."
Achieving rapid treatment for sepsis patients requires creating a clinical culture that does not penalize clinicians for "false-alarm" diagnoses, O'Brien says. "We have to be really careful to understand that clinicians are doing a difficult task in trying to figure out what to do, because this is a disease for which there is no single test that says, 'This is absolutely sepsis.' They are making decisions with uncertainty."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Sepsis is one of the deadliest medical syndromes in the United States, claiming about 270,000 lives annually.
HCA Healthcare has developed a computer-based decision support tool that can detect sepsis about 18 hours earlier than the best clinicians.
OhioHealth has decreased sepsis mortality through educating staff, rapid diagnostic testing, reducing the medication response time of hospital-based pharmacists, and creating a clinical culture that tolerates false positive diagnosis.