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Salud14 junio, 2022

Is the Sepsis Care Bundle a missed opportunity for hospitals?

Sepsis accounted for 20-25% of global deaths in 2020, according to a landmark study from the World Health Organization (WHO). Though sepsis rates have held steady in recent years, sepsis treatment costs have skyrocketed in the United States. The Lancet estimated 60.2 million cases of sepsis in 1990 and 48.9 million cases globally in 2017. With the increasing burden of chronic disease, the value of proper use of the Centers for Medicare and Medicaid Services (CMS) sepsis treatment bundle, or SEP-1, is only increasing.

Using diabetes as an example, a recent Swedish study of over half a million patients found that sepsis was independently associated with a four-fold more significant risk of death for patients with type 2 diabetes.

Sepsis rates have held steady in recent years — even declining in some cases — however, treatment costs have skyrocketed in the United States. Sepsis is the most expensive hospitalization episode of care. More than $55 million is spent on sepsis care in hospitals every day. The total cost of sepsis hospital care for the entire U.S. population was $57.47B in 2019, before the COVID-19 pandemic.

With the help of SEP-1, healthcare leaders can make improving sepsis care a critical goal that aligns with value-based care goals and improved patient outcomes. But, care teams will need standardized processes and advanced technology to realize the clinical and financial benefits of the sepsis bundle and overcome the challenges that SEP-1 adherence often presents.

Patient outcomes are improved with the SEP-1 bundle

The use of the SEP-1 bundle is proven to improve care outcomes. In 2012, the state of New York began requiring compliance reporting from hospitals on their treatment of severe sepsis and sepsis shock. A 2019 study published in the journal Critical Care Medicine found that in situations where patients were treated according to the requirements:

  • There was an overall reduction of 4.3% in sepsis mortality in New York, a 30% improvement over the average mortality rates in four control states.
  • Patients had a 15% lower likelihood of mortality.
  • With a 3-hour SEP bundle, the length of stay was reduced by almost three days. With the 6-hour bundle, it was over 24 hours shorter.

The benefits of a strategic and tech-enabled approach to treating sepsis are obvious for patients. A 2016 study from the Journal of the American Medical Informatics Association found that electronic surveillance, change management, and surveillance algorithms to detect sepsis resulted in a 53% decrease in mortality and a 30-day readmission rate that fell from 19.08% to 13.21% during the control period. The surveillance algorithms adjusted clinical parameters based on comorbid medical conditions to improve specificity and sensitivity. Nurses participating in the study also received mobile alerts for positive sepsis screenings, shock, and severe sepsis.

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Standardizing compliance with the sepsis bundle is complex

Treatment in compliance with the SEP-1 bundle is effective in many ways, but standardizing compliance remains a challenge for many teams.

A 2022 study examined the association between 30-day mortality among Medicare beneficiaries and compliance with the SEP-1 quality measure, finding a reduction in the mortality rate for care compliant groups (21.81% vs. 27.48% for the noncompliant group). However, hospitals that report SEP-1 data have compliance rates of just under 50%, according to Hospital Compare. Low compliance rates mean that providers and patients are missing out on the benefits of reduced mortality and shorter length of stay that are possible with the SEP-1 bundle.

Thankfully, the challenges behind low levels of compliance are becoming more apparent. The Society of Critical Care Medicine (SCCM) examined barriers to sepsis bundle achievement, including staffing, communication, and process and documentation issues. The primary obstacles were:

  • Delayed sepsis recognition and treatment
  • Insufficient documentation
  • Insufficient knowledge of the importance of lactate
  • Prolonged lab turnaround times
  • Limited IV access and pharmacy resources (such as delayed bedside delivery)
  • Missing notes in EHRs
  • Inability to account for fluid volume before starting vasopressors
  • Unavailability of the clinician(s) to perform a reassessment

SCCM’s suggested solutions include increased staff education, real-time feedback, routine screening, nurse-driven protocols, routine use of a sepsis timer, and collaboration with EMS and infectious disease departments to reduce variability in care.

Hospitals must go beyond EHRs to see results

Many EHRs offer solutions to monitor sepsis patients, but recent findings have questioned how effective they are. Hospitals may need to look to other technologies for reliable support.

For example, University of Michigan Medical School researchers found that the Epic sepsis prediction model missed a significant number of sepsis patients and caused false alarms. When used within the recommended score range, the penalized logistic regression model only identified 7% of sepsis patients who a physician did not recognize. It failed to identify two-thirds of patients with sepsis and generated alerts on 18% of hospitalized patients, contributing to clinicians’ alert fatigue.

While these results have been disputed, the unreliable nature of EHR features leaves clinicians needing better options for gathering the clinical insights necessary to improve sepsis outcomes.

A more advanced sepsis surveillance solution can use population monitoring, point-of-care alerts, and analytics to inform compliance. It can also highlight opportunities in change management. This type of technology has been found to outperform EHRs, delivering:

  • 54% reduction in sepsis mortality
  • 31% reduction in readmissions
  • 95% alert sensitivity in detecting sepsis
  • 82% specificity in decision support at the point of care

Sepsis management is an evolving challenge, but there is a path forward. Explore focused-expert solutions beyond the generic EHR sepsis alerts to provide early and accurate sepsis alerts.

Download the corresponding infographic and learn about best practices in coordinating sepsis care across your hospital in our guide.

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Dr. Itay Klaz is responsible for directing clinical efforts toward the development, implementation and support of Wolters Kluwer Sepsis Surveillance software solutions.
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