“Saving one’s life or one’s child’s life should not be luck of the draw.”
These were the words that stuck with me most when I interviewed Ciaran Staunton last week, the father of Rory Staunton, a 12-year-old boy who tragically died from sepsis in 2012.
The story of Rory Staunton is a powerful one, an emotional undertaking for anyone to write or read. It can probably be best told here, in a story last month in People Magazine, but I will do my best to sum up the important details for the context of this piece.
In March 2012, during a normal school day in Jackson Heights, N.Y., Rory got a cut on his arm in gym class while diving for a ball. According to the People report, a gym teacher—not a nurse—put two Band-Aids on the cut without stopping to clean the wound first. The next day, Rory visited his pediatrician’s office, as he began to vomit with a 104-degree fever while complaining of pain in his leg. Then came a trip to the ER at NYU Langone Medical Center, where doctors treated him for dehydration and an upset stomach. But Rory’s fever would not subside; the next day he was brought back the ER, this time to the ICU. His parents were told that night that Rory was fighting for his life. According to the story in People, “Rory’s body was in septic shock brought on by an avalanche of responses his immune system was bringing to bacteria that had gotten into his blood through the cut in his arm.” Two days later, Rory would lose the battle, dying in the ICU.
In America, sepsis kills more people than AIDS, breast cancer, and stroke—combined. Worldwide, someone dies from sepsis every four seconds, according to an educational video embedded inside the People story. Now, according to the Centers for Disease Control and Prevention (CDC), sepsis is a medical emergency. Every year there are at least 1.7 million cases of sepsis and 270,000 deaths, the CDC says. What’s more, up to half of hospital deaths are due to sepsis, according to research published in the Journal of the American Medical Association.
Sepsis starts with any kind of infection or any time germs enter the bloodstream; in Rory’s case, the cut from gym class. The human body tries to fight the infection, but fails. The organs shut down, one by one. But what’s unique about sepsis, compared to cancer, for instance, is that there is a known cure—usually antibiotics and fluids are suffice. Therein lies the challenge in the medical community, though, since the issue here is about detection rather than treatment.
While speaking with Ciaran Staunton last week, I also spoke with Sean Benson, vice president and general manager of specialized surveillance at Wolters Kluwer, a global information services company with one of its specialties being healthcare. Benson is the creator of a sepsis surveillance tool created a few years ago that has proven to reduce sepsis mortality by more than 50 percent as well as reduce the 30-day readmission rate from 19 percent to 13 percent. What’s more, the system had observed sensitivity of 95 percent and specificity of 82 percent for detecting sepsis compared to gold-standard physician chart review, according to the research.
Explaining further, Benson says that the single biggest challenge seen over the years with sepsis, a challenge that was taken on by his team when it started to build out the product, is that alert fatigue is a huge problem with clinical systems. “If we can’t build a system that has very limited alert fatigues, one that is highly accurate and identifies patients very early in the condition, then there won’t be any value,” says Benson. “We have studied what the EHRs [electronic health records] and other systems have done, and they have very low ‘specificity,’ which basically ties to the accuracy of the alert. So they can perhaps be good in catching and identifying the patients at some point in the process, but there is a lot of over-alerting and false positive alerts.”
Indeed, a KLAS report from earlier this year which interviewed providers who are employing sepsis solutions noted that because most EMR vendors lack easily deployed sepsis solutions, some providers are looking to other sources, with infection control and surveillance vendors such as Wolters Kluwer and VigiLanz perceived as most focused. “(Wolters Kluwer’s) POC Advisor pulls data out of our EHR to an engine with all of these rules and then shoots alerts to mobile devices,” the research report quoted one CMIO.
It should be noted that the KLAS report also stated that the adoption of Cerner’s and Epic’s sepsis technology is higher than all other sepsis solutions combined, with customers of both reporting improved outcomes, including mortality reductions. The report quoted an IT director as saying, “We have been using (the Cerner sepsis) product for seven months with excellent results.”