Washington Hospital Better than National Average in Combatting Deadly Sepsis
Quality improvement initiatives help lower sepsis mortality rate
Severe sepsis - the body's system-wide inflammatory response to infection - is the tenth leading cause of death in the U.S., killing more than 500 people each day. In hospitals nationwide, between 40 percent and 60 percent of patients with severe sepsis die.
During its April meeting, Washington Township Health Care District's Board of Directors learned about efforts to combat sepsis at Washington Hospital. For the last seven years, the Hospital has worked very hard to lower the mortality rate from sepsis.
As of 2013, the percentage of patients at Washington Hospital who died from sepsis was far better than the national average, and the Hospital continues to make efforts to lower the percentage even further.
Sepsis - sometimes referred to as "blood poisoning" - can start with a simple infection or trauma, and the body's initial reaction may be mild. However, the condition can lead very quickly to a serious infection. As the reaction becomes more severe, organs in the body - including the kidneys - may stop functioning. The patient may go into septic shock, with a marked drop in blood pressure, and this can lead to death. The progression can happen very quickly - within hours.
Washington Hospital's physicians, nurses and pharmacists follow numerous strategies shown to improve patient outcomes from sepsis:
* Preventing sepsis from occurring in the first place
* Identifying the infection early by screening all patients
* Starting treatment quickly
* Monitoring patient outcomes and Hospital performance to identify further ways to improve
The Hospital's increased focus on combatting sepsis started in 2007, when it was selected by the Gordon and Betty Moore Foundation as a pilot site to implement evidence-based practices for sepsis recognition and treatment. It put together a team of nurses, physicians, pharmacists and staff from other disciplines. The interprofessional team worked to improve screening, identification and compliance with interventions that have proven successful in achieving better patient outcomes.
Although nationwide mortality from sepsis was 40 to 60 percent, the Hospital targeted an even lower percentage. One of their strategies has been compliance with what is called the "sepsis bundle."
In hospitals, a bundle is a group of proven interventions that, when completed quickly, can lead to a better outcome for the patient. Studies have shown that, to be effective, the sepsis bundle must be completed within three hours of the patient's arrival in the Emergency Department (ED) or within one hour of arrival in the Intensive Care Unit (ICU). Steps include checking the lactic acid level in the blood, drawing blood cultures, and giving antibiotics and fluids, as well as administering drugs that help increase blood pressure to a normal level.
The more a hospital complies with the sepsis bundle, the lower the mortality rate. The team at Washington Hospital works very hard to make sure bundle compliance within the recommended timeframe.
In another initiative, the Hospital collaborated with Alameda Emergency Medical Services and Highland Hospital in a research study to determine if outcomes from sepsis could be improved by having emergency medical technicians (EMTs) prescreen patients for sepsis before they reached the hospital. This enables the ED to start the sepsis bundle more quickly.
Preliminary findings data gathered by Washington Hospital showed that the hospital decreased sepsis mortality during the study period from 29 percent to 10 percent. In addition, the mortality from sepsis patients with pneumonia dropped from 59 percent to 33 percent.
As work continues in its ED and ICU, Washington Hospital is refocusing its efforts on early recognition and treatment of sepsis in the Medical/Surgical units, where there has been a higher sepsis mortality rate. The Hospital has been accepted as one of 65 national participants in the 18-month Surviving Sepsis Campaign's Sepsis on the Floors Quality Improvement Collaborative.
In an effort to the lower the sepsis mortality rate even further, the Hospital will identify and treat sepsis in its Medical/Surgical units, monitor its performance results over time, provide further education to staff, check the latest research, and benchmark with other organizations.
To find out more about Washington Hospital's Quality Improvement initiatives, visit www.whhs.com/quality.