Hospital Sepsis Program Lowers Death Rates and Costs

A novel sepsis detection and management program helps decrease intensive care unit (ICU) and inpatient death rates and costs, according to a new study.

Researchers at Houston Methodist Hospital (HMH; Houston, TX, USA) implemented the sepsis program in 2008 to help with the early recognition of patients showing signs of possible infection. The interventions implemented consisted of four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record (HER); creation of specific screening and response protocols; and education and training of nurses.

The program called for daily screenings of patients on targeted units by bedside nurses, and nurse practitioners initiated definitive treatment as indicated. The results showed that by the third year of the sepsis program, 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in the first year. Inpatient sepsis-associated death rates decreased from 29.7% in the pre-implementation period (2006–2008) to 21.1% after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries also decreased from pre-implementation levels.

According to the researchers, the main factors in the program’s success are a focus on all inpatients, not just patients in the ICU; the goal of identifying sepsis early, before it progresses to severe sepsis and septic shock; that nurses are the frontline implementers of screening and response protocols; the intensive simulation training that second-responder nurses undergo; and seamless integration of the screening tool into the hospital’s HER, supporting bedside patient care. The study was published in the November 2015 Issue of the Joint Commission Journal on Quality and Patient Safety.

“Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU,” said lead author Stephen Jones, MD, MSHI. “In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it.”

Common symptoms of sepsis include those related to a specific infection, but usually accompanied by high fevers, hot, flushed skin, elevated heart rate, hyperventilation, altered mental status, swelling, and low blood pressure. Sepsis, which causes millions of deaths globally each year, is the result of whole-body inflammatory state caused by an immune response to serious infection, most commonly bacteria, but also fungi, viruses, and parasites.

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