Search “sepsis” online and the first sentence of almost every article that comes up is some version of its definition. Sepsis needs that immediate explanation because, despite being the leading cause of death in U.S. hospitals and the most expensive condition treated in hospitals, many people don’t have a deep understanding of what it is.
In recent years, there have been major efforts to improve awareness, diagnostic tools and treatment protocols related to sepsis. Those efforts have resulted in improvements, but there is still a significant need for practical, actionable guidance for care teams identifying and treating patients with sepsis.
While new reports highlight the state of sepsis care, and the steps hospitals can take to improve their sepsis programs, Novant Health’s sepsis program provides insights into the effect those recommendations have on patient outcomes.
Tracking sepsis care
Today, hospitals have more data than ever before on the protocols and organizational structures used to treat patients with sepsis. In 2023, the CDC released the Hospital Sepsis Program Core Elements to help hospitals strengthen and standardize their sepsis programs. At the same time, the CDC expanded the National Healthcare Safety Network (NHSN) Annual Hospital Survey to measure how closely hospital sepsis practices align with the Core Elements. Greater alignment has been associated with lower patient mortality, shorter hospital stays, and reduced healthcare costs.
This year’s survey of thousands of acute care and critical access hospitals across the U.S. showed nationwide improvement in 24 of the 28 sepsis program priorities. Most hospitals reported having a sepsis program or committee (82%) and almost all had standard processes to screen for sepsis (93%). But the survey also found gaps in leadership and communication in a majority of reporting hospitals.
Only about one-third of hospitals said they have a sepsis coordinator (36%), have a sepsis program leadership structure with one nurse and one physician (36%), and routinely share sepsis treatment and outcome data with clinicians and hospital leadership (31%).
“It’s critical to have sepsis program leadership who organize clinical practice changes by sharing sepsis data. These leaders bring all of our hospitals together as a system to standardize sepsis care,” said Dr. Dan Feinstein, codirector of Novant Health’s sepsis program.
Dr. Feinstein’s work involving sepsis dates back decades and includes a 2006 research paper that became part of the international Surviving Sepsis Guidelines. He’s since played a key role in the development and adoption of policies across the Novant Health system that have resulted in a 40 percent reduction in sepsis mortality since 2021.
“Sepsis is one of the most common patient diagnoses we see throughout this country. We have to have a sepsis program to be prepared to handle these volumes with an organized team approach. The care we deliver is timed and we have to have fast pathways of care. All of these goals require an investment in a strong sepsis program,” Dr. Feinstein said.
Sepsis care framework
While the NHSN survey tracks what’s been happening, a panel of experts is laying out a framework for hospitals looking to improve future sepsis care.
The Multisociety Position Paper: Hospital Strategies to Improve Sepsis Outcomes brought together medical experts from different backgrounds and organizations to address gaps in sepsis care that the group says have been left unfilled by existing guidelines.
The result is a series of practical and actionable recommendations for hospitals across six main topics:
- diagnostic testing and pathogen detection
- antimicrobial management and delivery
- surveillance and performance metrics
- adjunctive therapy
- program infrastructure and organizational support
- infection prevention
Acknowledging that not every hospital has the capacity to adopt every recommendation, the panel classified each strategy into tiers, with Tier 1 being the highest priority of adoption and Tier 2 a moderate priority.
Novant Health has already implemented all Tier 1 recommendations, and nearly every additional recommendation has either been adopted or is in the process of being integrated into our sepsis program.
“These recommendations get reviewed every few years. They are based on expert opinions and the latest research in the field of sepsis care. Hospitals need to take advantage of this information to adopt new strategies and technology to ensure we give these patients the best chances to recover and in some cases survive their sepsis illness,” Dr. Feinstein said.
A key part of Novant Health’s coordinated effort to improve early sepsis identification and treatment that Dr. Feinstein helped develop is the adoption of Sepsis-2 criteria. But there also needs to be supporting processes to make treatment successful.
“Our sepsis program develops order sets, antibiotic strategies, sepsis diagnostics, and early identification methods for the entire Novant Health System,” Dr. Feinstein said. “We get contributions from each hospital’s experts and from nearly every medical specialty. Therefore, no matter what Novant Health hospital you seek care from, you will get the same, aggressive sepsis care in order to improve rapidly.”
Because of the sepsis treatment policies implemented across Novant Health’s hospitals, 28-30 patients survive sepsis each month that predictive models indicated were unlikely to survive.
“The recommendations by this expert panel are really the core of what we’ve been doing at Novant Health for years and the result is our ability to keep people alive and well even though they were predicted to not survive,” Dr. Feinstein said. “Implementing our approach to sepsis care at scale could have a tremendous effect on lowering sepsis mortality throughout our region and nationally. This is especially important in North and South Carolina where we have some of the greatest opportunities to improve outcomes.”
