By Katherine Virkstis, Managing Director
Sepsis is lethal, expensive, and all too common.
According to CDC, it's responsible for up to 33% of inpatient deaths. Treating sepsis often requires treatment in the ICU and prolonged hospital stays, leading to high associated costs, with a typical sepsis case costing nearly 70% more than a non-sepsis case.
So how can your organization identify sepsis early and treat it effectively? Join us for a webconference on Thursday, April 19 to learn how St. Joseph Hoag Health created a dedicated sepsis nurse program and how you can use sepsis nurses at your organization.
Once you've registered, read on to learn the three keys to reducing sepsis mortality rates, including nine best practices you can adopt today.
Key #1: Detect sepsis early
Sepsis is difficult to recognize, and missed or delayed diagnoses can have tragic consequences. So your triage team must be vigilant. We've identified three ways you can detect sepsis cases earlier:
- Screen every emergency patient: Advisory Board data show that 83% of sepsis patients had the condition upon admission. ED assessment is the best means to ensure the earliest identification, so screen universally at triage, and assess your detection performance by monitoring sepsis admissions per 1,000 ED cases.
- Prioritize top associated infections: Common infections such as UTIs, pneumonia, and abdominal infections lead to a majority of sepsis cases, so train frontline staff to rigorously screen patients with these conditions for sepsis.
- Recognize geriatric patients are at high risk: Geriatric patients are 13 times more likely than other adult patients to contract sepsis, and 65% of all sepsis cases occur in geriatric patients. With a mortality risk over 40%, it's best to treat every elderly patient as a high-risk case. This means lowering the threshold for a positive systemic inflammatory response syndrome (SIRS) screening in the elderly and recognizing atypical signs such as altered mental state.
Key #2: Treat sepsis rapidly
With sepsis, time is of the essence. Failure to treat the condition within six hours worsens the prognosis—and mortality increases 7.6% for every hour of delay in administering antimicrobials. Use these three best practices to ensure rapid treatment:
- Order lactate with blood culture: While guidelines recommend drawing lactate and blood cultures within six hours of a positive sepsis screening, many sepsis patients don't receive a timely lactate test. But providers can lower that time gap by using standardized sepsis order sets, acting immediately on EHR alerts that occur when a series of warning signs are present in a patient's record, and having on hand prepared sepsis packets with necessary supplies for immediate use. Nurses also can be a valuable resource, so enable them to practice at the top of license by ordering lactate testing.
- Reduce ICU length of stay: The direct costs of treating a sepsis patient in the ICU are six times greater than those for a non-sepsis ICU patient, according to our data. Early intervention can reduce a patient's ICU stay and, as a result, your hospital's costs. That's why it's vital for hospitals to hold clinicians accountable for initiating the sepsis bundle within the critical time window, and to create clear protocols for transitioning acute patients to the ICU.
- Re-evaluate vasopressor guideline: Researchers are currently evaluating which vasopressors are most effective against septic shock. In observational studies, dopamine use has been associated with cardiac events and poorer outcomes. Critical care physicians must remain informed about the evolving evidence base and adjust their practices and protocols to reflect that evidence.
Key #3: Prevent sepsis both inside and outside of the hospital walls
It's also important to look outside your hospital's walls and into the community. That's where you can find partners to supplement your hospital's prevention efforts and identify sepsis patients before they arrive at the hospital.
- Prevent hospital-acquired sepsis: Hospital-acquired sepsis occurs only 9% of the time at the top-performing quartile of hospitals, according to Advisory Board research—but 22% of the time for the bottom-performing quartile. This suggests that many hospitals have an opportunity to prevent sepsis by boosting their infection-control compliance, with a focus on hand-washing, surgical sterility, antibiotic stewardship, and MRSA screening.
- Extend infection control to the community: Half of hospital sepsis patients visited a physician's office 30 days before admittance. Hospitals and health systems can educate physician practices on infection control, antibiotic selection, immunization, and sepsis screening to catch more cases upstream.
- Prevent readmissions for sepsis: Our research shows more than one-third of sepsis patients are readmitted within 30 days of discharge, suggesting staff may not be providing appropriate antibiotic treatments to discharged sepsis patients. Hospitals should train staff to better manage the discharge instructions and prescriptions for patients recovering from sepsis to prevent readmission of these patients.
Next, join us to learn the benefits of hiring a dedicated sepsis nurse
St. Joseph Hoag Health began using dedicated sepsis nurses in 2015 to reduce their sepsis mortality rates by following these and other best practices. As a result of their program, Hoag Health's mortality rate from severe sepsis/septic shock has fallen dramatically, from 15% to 9% since 2015.
Join nursing leaders from St. Joseph Hoag Health for a webconference on April 19 to learn how they created their dedicated sepsis nurse program and how you can use sepsis nurses at your organization.
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