HealthSeptember 06, 2016

Sepsis: Reducing mortality and cost through screening

September is Sepsis Awareness Month, and World Sepsis Day is September 13. Follow events and discussions @SepsisAlliance and #sepsis.

Author: William Alvarez, Jr., PharmD, BCPS, and Christine M. Cohn, PharmD, BCPS

Sepsis has long been a challenge in health systems across the U.S., where every year, 258,000 patients die from sepsis, and expenses have mounted to nearly $24 billion!

According to the Centers for Disease Control and Prevention (CDC), sepsis is the body’s overwhelming and often fatal response to infection.

Hospitals are fighting back with programs for early detection of infection and EMR-integrated screening to help alert professionals to potential signs of sepsis. Efforts include [POC Advisor], a new decision support solution from Wolters Kluwer developed specifically to help professionals identify and manage sepsis through patient-specific alerts and evidence-based treatment advice, including key content from Wolters Kluwer Clinical Drug Information, to assist with medication therapy after sepsis has been identified.

Recent studies and discussion of the issue of sepsis show how hospitals can improve outcomes by combining decision support screening with change management for sepsis protocols and best practices.

A problem defining sepsis

The Society of Critical Care Medicine and the European Society of Intensive Care Medicine recently convened a task force to establish new definitions and clinical criteria for sepsis and septic shock. These definitions were examined in “Redefined Sepsis Affects Coding, Documentation,” an August 2016 article published in online health information magazine, For The Record.

The lack of a definitive diagnostic test for sepsis forces clinicians to rely on an observational checklist, Stephen Claypool, MD, explained in the article. “It's a clinical diagnosis based on observation, infection, and how the patient is doing,” he said. “But, for sepsis, survival is dramatically improved if it's caught and treated early with antibiotics and fluid. Under the old definition, when people had two SIRS (systemic inflammatory response syndrome) abnormalities due to infection, they called it sepsis. However, other conditions also can cause SIRS. It's not isolated to just sepsis. Because of that, physicians have been reluctant to call SIRS-positive cases sepsis and, as a result, may not treat the condition in a timely fashion.”

Claypool argues that physicians should classify all SIRS-positive patients as “rule-out sepsis” and begin evaluation and treatment for the condition while determining whether or not a patient is actually septic.

Consistent with Claypool’s use of SIRS-based criteria for identifying sepsis, the Centers for Medicare & Medicaid Services (CMS) recently announced it will not change the sepsis definitions used in its SEP-1 sepsis management inpatient quality measure, implemented October 1, 2015. The definitions used in the SEP-1 measure (NQF #0500), which CMS described as “widespread and understood,” delineate sepsis as SIRS due to an infection and severe sepsis as sepsis with acute organ dysfunction.

Read the full article to learn more.

Decision support’s impact on Sepsis mortality

In May 2016, Claypool and his colleague, Sharad Manaktala, MD, PhD, published a study in the Journal of the American Medical Informatics Association (JAMIA) titled “Evaluating the impact of a computerized surveillance algorithm and decision support system on sepsis mortality.” The study used POC Advisor, a real-time electronic surveillance system, which sent mobile alerts to nurses for all positive sepsis, severe sepsis, and shock screenings over a period of 10 months. The subject pool was assessed in comparison to sepsis mortality rates during a control period from 2011 to 2013.

The results revealed positive impacts from using patient-specific decision support screenings at the point of care:

  • 53% decrease in sepsis mortality
  • 19.08% decrease in 30-day readmission rate

Read the full study for more details.

Cost containment opportunities

A 2014 article in HFMA’s Strategic Financial Planning newsletter examined [”The Greatest Inpatient Cost Opportunities.”] Mining MEDPAR data to discover potential cost-cutting opportunities within healthcare, the article singled out sepsis, noting that sepsis discharges increased 36% between 2008 and 2012.

While hospitals showed varied results — some incurred increased sepsis-related costs over that period, while some decreased spending despite increase in number of cases — both groups were able to reduce mortality rates. Improving quality of care and detection for sepsis reduced the average cost per case from $2,069 to $1,616.

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