Varadarajan Subbiah, M.D., MBA

Sepsis is a life-threatening condition that occurs when the body has an extreme reaction to an infection. Like falling dominoes, sepsis triggers a rapid escalation of problems that can lead to tissue damage, organ failure and death if not treated in time.

But diagnosing and treating sepsis can be challenging, in part because its symptoms can be vague or mistaken for other health problems.

ChristianaCare is launching an initiative to identify signs of sepsis earlier, as swift action can prevent its serious adverse outcomes.

Each year, about 1.7 million people in the United States develop sepsis, and about 16% (or 270,000) of those people die, according to statistics from the Centers for Disease Control and Prevention (CDC). Among patients who die in a hospital, one in three has sepsis, making it a top cause of death in hospital intensive care units across the country.

ChristianaCare’s sepsis mortality rates are about half of the national average, but ChristianaCare is on a mission to get those rates down to zero, said Varadarajan Subbiah, M.D., MBA, FACP, vice president of Utilization Management and Quality.

“We need to treat sepsis as an equal to other illnesses such as stroke or myocardial infarction,” he said. “We need to identify it and treat it as soon as we suspect it.”

To do this, ChristianaCare is introducing a series of protocols, tools and educational resources to its clinicians. The initiative, “Get Ahead of Sepsis,” echoes the CDC’s efforts to help providers recognize, document and treat sepsis in patients early.

“To get ahead of sepsis, we’re bringing three steps — recognition, documentation and treatment — into a single, dedicated process so that it’s seamless,” he said.

Recognizing sepsis symptoms

Symptoms of sepsis include high heart rate, low blood pressure, breathing problems, fever, shivering, confusion and extreme pain.

At higher risk are people ages 65 and older, those with chronic medical conditions or weakened immune systems, children under age 1 and people recently hospitalized with a serious illness.

Advances in the detection and treatment of sepsis, along with earlier treatment protocols, have made it easier for providers in the hospital to diagnose sepsis and treat patients.

In a hospital setting, recent advances include the use of technology that automatically scans electronic health records and alerts providers about changes in a patient’s condition that might indicate sepsis.

Documenting suspected sepsis

Jennifer Brettler, D.O.

“There used to be a lot of barriers to documenting suspected sepsis, because there are so many different criteria,” said Jennifer Brettler, D.O., medical director of Clinical Documentation Integrity.

“Our goal is this: If you suspect sepsis, say sepsis. We can always rule it out if it’s not.”

Because the symptoms of sepsis can often be unclear or confusing, there can be a natural tendency for health care professionals to hesitate in diagnosing sepsis while they work to obtain more information or rule out other possibilities, Brettler said.

ChristianaCare’s Get Ahead of Sepsis initiative aims to eliminate that hesitation by encouraging providers to act quickly in diagnosing possible sepsis — even when the diagnosis is uncertain — so that it can either be confirmed or ruled out early.

Sepsis is one of the most resource-intensive medical inpatient conditions, Brettler said.

“Moving in the direction of considering it early when a patient presents with sepsis-like symptoms can decrease time to treatment and improve patient outcomes,” she said.

“If the patient has infection and related organ dysfunction, then let’s think about sepsis,” Brettler said. “If a patient has unexplained organ dysfunction we should also think about sepsis.

“Our goal is this: If you suspect sepsis, say sepsis. We can always rule it out if it’s not.”

— Jennifer Brettler, D.O.

ChristianaCare’s new systemwide initiative will customize the standard St. John Sepsis Surveillance Agent alert system, which scans patient electronic medical records (EMR) for abnormal vital signs and lab values that indicate sepsis, with indicators for infection and organ dysfunction, Subbiah said.

When a patient has symptoms that suggest sepsis, an automated pop-up alert will appear in the patient’s electronic medical record (EMR), calling a provider’s attention to the possibility of infection. Providers then make clinical decisions to determine whether the patient has sepsis.

Treating sepsis

“If providers believe the patient has sepsis, not only will it add that diagnosis to the chart,” Brettler said, “it will also take you directly to the sepsis decision support tool, where they can then order everything that’s necessary for the patient with sepsis or suspected sepsis.

“Keeping our patients safe from harm due to unrecognized sepsis is the biggest thing that we want to achieve.”

— Varadarajan Subbiah, M.D., MBA

“All of those orders are part of treatment protocol known as the SEP-1 bundle recommended by the Centers for Medicare & Medicaid Services,” Brettler said.

“It’s a big change that we anticipate will have very positive effects.”

The new process helps to prioritize and streamline sepsis diagnosis and get treatment to patients faster. The protocol for sepsis treatment is broad spectrum antibiotics, IV fluids, if necessary, and monitoring of vital signs and laboratory studies, Subbiah said.

When the updated St. John sepsis alert and the sepsis decision support tool are released in mid-November 2023, ChristianaCare clinicians will have access to on-site support and other resources to help them navigate the new technology.

ChristianaCare will offer systemwide sepsis education to providers in the coming months, which will count toward continuing medical education (CME) requirements.

The initiative will also incorporate fact sheets and recommendations from the CDC’s Get Ahead of Sepsis campaign, urging providers to know the risks, spot the signs and act fast.

Together, these measures are expected to reduce in-hospital mortality related to sepsis, as well as patient length of stay and health care costs.

“Keeping our patients safe from harm due to unrecognized sepsis is the biggest thing that we want to achieve,” Subbiah said.

“The fact that we can put that sepsis documentation in the chart alerts the rest of the care team that we’re dealing with sepsis, or likely dealing with sepsis.

“It puts everyone on a heightened state of alert and gets treatment to patients faster. The result is better care and better outcomes for our patients.”



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