June 22, 2017

The nurse-led strategy that sharply cut sepsis deaths at St. Joseph Hoag Health

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Oct. 15, 2019.

    After establishing a dedicated team of sepsis nurses, St. Joseph Hoag Health in Orange County, California, cut its mortality rate for sepsis patients, as well as patients' length of stay, Anna Gorman writes for Kaiser Health News.

    Background

    According to Sepsis Alliance, sepsis is the leading cause of death in U.S. hospitals, killing up to 50 percent of the estimated one million people who acquire a severe sepsis infection each year. The condition also takes a toll on hospital finances, Gorman writes, costing hospitals an estimated $24 billion per year.

    St. Joseph Hoag Health's seven hospitals treat about 8,000 sepsis patients per year, according to Andre Vovan, a critical care physician who supervises the health system's antisepsis programs. He said overall, the cases cost the health system an estimated $130 million annually.

    Personalizing a nationwide initiative

    CMS in 2015 began mandating that hospitals report on their efforts to treat sepsis. Among other steps, hospitals in the first three hours post-diagnosis of sepsis have to get blood cultures, start an IV, and begin administering antibiotics. According to Gorman, sepsis if spotted early can be treated effectively—but it's a difficult diagnosis, and if patients aren't treated promptly enough, they can experience septic shock, putting them at risk of organ failure and death.

    While many hospitals have established some sort of sepsis program, St. Joseph's approach is unusual in that it designates nurses and care coordinators to focus on sepsis, Gorman writes. "From a clinical point of view, from a cost point of view, they make a huge impact," said Tom Ahrens, a member of the advisory board of Sepsis Alliance.

    Nurses key to St. Joseph's initiative

    The health system in 2015 began posting dedicated sepsis nurses and care coordinators throughout its facilities, in addition to establishing sepsis care checklists and a mobile application designed to help organize care for sepsis patients.

    The dedicated nurses identify and monitor patients at risk of sepsis—such as those suffering a urinary tract infection, pneumonia, or another type of infection—to ensure that patients who develop the condition can be treated quickly. According to Gorman, every patient identified as a potential sepsis case is monitored for at least 24 hours, during which time the dedicated sepsis nurse will make periodic visits and educate patients about sepsis. A sepsis nurse at any given time might be keeping an eye on a patient's blood pressure, heart rate, white blood cell count, and level of disorientation.  

    Sepsis nurses also make sure that sepsis patients' families know what to expect while the patient is in the hospital and after he or she is discharged. "We want the families to understand that just because you survive sepsis, it doesn't mean you can get home and run a marathon," Vovan said. "It can take weeks to months to recover."

    More broadly speaking, the nurses also ensure that the standards required by CMS are being followed in the hospital, according to David Carlbom, medical director at Harborview Medical Center. For instance, Rosemary Mitchell Grant, the sepsis nurse coordinator at Harborview, informs staff about the condition, monitors sepsis data collected through medical records, and implements initiatives aimed at improving patient outcomes.

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    Results

    St. Joseph's program seems to be working, Gorman writes. The health system's mortality rate from severe sepsis/septic shock declined from 15 percent in 2015 to 12 percent in 2016, and from 12 percent to 9 percent for all sepsis cases in general over the same time period, Vovan said. According to Vovan, the overall length of stay for such patients is also declining.

    In addition, at least one hospital—St. Joseph Hospital in Orange County, California—the number of patients who experienced septic shock declined by half between 2015 and 2016.

    And the program has garnered support from physicians, Gorman writes. As Matthew Mullarky, an ED physician at St. Joseph, put it, "With the knowledge [the nurses] have, they ensure we are moving in the right direction quickly."

    "We are the last line of defense," Dawn Nagel, a sepsis nurse at St. Joseph, added. "We're here to save lives" (Gorman, Kaiser Health News/Fierce Healthcare, 6/19).

    Why nurses are key to preventing never events

    Across the country, one in ten patients get a hospital-acquired condition (HAC) during their hospital stay. HACs can have serious consequences—beyond the patient safety issue, they cost a lot to treat.

    Preventing never events isn't getting easier, but no one is better equipped than nurses. Watch our video to learn more about the financial cost of HACs and the three key things to remember to prevent them.

    Watch the Video

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