Sometimes referred to as blood poisoning, sepsis is the body’s often-deadly response to infection. As many as 1.6 million Americans are affected by sepsis, and more than 258,000 of them die from it, every year. Yet sepsis remains not only misunderstood by the public—a recent study by Harris Poll on behalf of the Sepsis Alliance in June 2014 found that only 44 percent of Americans had even heard of sepsis—it also remains challenging for physicians and other clinicians to work with. There are a variety of reasons that sepsis remains such a huge, unmanaged problem, in hospitals and emergency departments. But there are those who are working to change the situation. And there are things that IT professionals, especially clinical informaticists, can do, to turn things around.
One clinician leader who is in the thick of efforts to educate about sepsis and turn things around in his own organization is Jim O’Brien, M.D., vice president of quality and patient safety at Ohio Health Riverside Hospital, one of 12 hospitals in the Ohio Health system. O’Brien is involved in studying sepsis treatment patterns at Ohio Health Riverside Hospital and its sister hospitals in the Ohio Health system; what’s more, he is also chairman of the board of directors of the Sepsis Alliance. Dr. O’Brien spoke recently with HCI Editor-in-Chief Mark Hagland about his work both at the Ohio Health system, and through the Sepsis Alliance, in this area. Below are excerpts from that interview.
Jim O'Brien, M.D.
Where are we as a healthcare system on the journey towards minimizing sepsis?
My experience is that the majority of CEOs and CMOs think of sepsis from the perspective of being a healthcare-acquired infection, and that’s how it’s most often presented in the press, but the vast majority of patients with sepsis come into our facilities already with sepsis. So it’s very important to understand that. And one of the areas in which we’ve actually made the most progress is around eliminating or preventing sepsis in central line catheter infections, urinary tract infections, and surgical site infections; but in the majority of cases involving sepsis, the sepsis comes in with the patients. And if you went into the average CEO’s office and asked them what their door-to-balloon time was [the measure of the length of time required to get patients presenting with heart attack symptoms into a hospital’s cardiac catheterization lab], they’d know the answer generally. But ask them how long it takes to get antibiotics into someone with septic shock, and they won’t know. Still, the existing data suggests that there’s almost an 8-percent increase per hour in death due to a delay in antibiotic treatment for septic shock. So the length of time to get someone appropriate antibiotics is going to be critical.
In a large multi-system provision of care for septic shock—in a study of over 3,000 patients, the median time to get antibiotics into patients in hospitals, the majority of them presenting in EDs, was six hours. [A study published by the Center for Healthcare Research & Transformation at the University of Michigan noted that “[H]ospitalizations for septicemia rose sharply in both Michigan and in the United States from 2007 to 2011. This suggests an important shift in the disease burden of severe sepsis (one of several diagnoses categorized as septicemia.)]
Six hours is a terribly long time. Why so long?
I’ve got biases and opinions as to why the length of time involved here is so long. The first “why” is that we don’t treat sepsis and septic shock as a medical emergency. And if someone comes in with trauma or a stroke, most hospitals have a process that has been optimized for those issues. But in terms of how hospitals care for sepsis, we just consider sepsis to be a complication, and sepsis is mostly not treated as a medical emergency.
So if someone comes in with a heart attack, they are going to activate the heart attack team and whisk them off to the cath lab, because we know time matters. If someone comes in with septic shock, the doctor will write orders, etc. But the hospitals that treat this as a medical emergency will reduce this from about 25 percent mortality to about 10 percent. And the next question is, why don’t hospitals treat this as a medical emergency? There aren’t great pressures for them to do so. But it’s not part of core measures in HospitalCompare, nor is it an element in the annual U.S. News and World Report report on hospital quality; and there’s not much reporting on this. The Sepsis Alliance funds surveys, and our survey this year found that only 44 percent of Americans even knew of the existence of sepsis.
This makes me think of the sudden emergence of awareness around the Ebola outbreak, actually.
Yes, and what kills people with Ebola? Sepsis. It’s your body’s response to infection. There have been 2,800 people dying of Ebola in the last six months. Meanwhile, we have lost 2,800 Americans to sepsis in the last four days.
That’s a very dramatic statistical comparison. It’s reminds me of the Institute of Medicine’s 1999 report, “To Err Is Human,” that cited the 98,000 annual deaths that are caused by preventable medical errors every year. Some in the mainstream media noted that that figure was equivalent to a jumbo jet crashing every day.