Thanks to an aggressive approach, severe sepsis and septic shock – more common worldwide than breast cancer, colon cancer and AIDS combined and killing 1 patient in 4 – is on the decline at Mercy, the sixth largest Catholic healthcare system in the U.S. serving more than 3 million people annually.
Sepsis, which can begin with the tiniest bacterial infection, spreads through the body like wildfire. It can rapidly escalate into major organ failure (severe sepsis), loss of blood flow to tissues (septic shock) and finally death. While sepsis crosses all age barriers, people over 65 and those with weak immune systems are especially at risk.
“If you don’t identify and treat sepsis quickly, it becomes untreatable and deadly,” says Robert Taylor, MD, a Mercy critical care physician who has researched sepsis for nearly two decades. “If we intervene early, we can dramatically improve the patient’s condition in a short period of time. As clinicians, we have the ability and the responsibility to turn this tide.”
Although in 2008 an international group of experts pinpointed the steps to improve outcomes – gold standards embraced by the Institute for Healthcare Improvement – actually implementing the standards in hospitals has been unwieldy and slow. Recent studies suggest many hospitals nationwide are less than 25 percent compliant with recommended sepsis treatment guidelines.
To address this, during a nine-month period, Mercy in St. Louis closely tracked six specific patient “elements” via a robust integrated electronic health record and by using Mercy SafeWatch – one of the largest electronic intensive care units (ICU) in the nation which is wired to provide 24-hour vigilance to critically ill patients. As an example, when lactic acid accumulates in a patient’s blood beyond a certain threshold, septic shock treatment protocols are quickly triggered to increase blood flow to tissues.
Mercy in St. Louis has:
- Decreased severe sepsis deaths from 28 to 14.5 percent
- Decreased septic shock deaths from 46.7 to 18.5 percent
- Decreased ICU days in the hospital from 8 to 3.4 days
- Increased compliance of gold standard practices upwards of 94 percent
Besides the loss of lives, the money spent on sepsis is significant and expected to mushroom by 2020 with an aging population. In 2001, care for the average severe sepsis patient cost $22,100 with a total annual price tag of $16.6 billion.
“The payoff in saving lives is tremendous and so is the savings,” said Tim Smith, M.D., vice president of research at Mercy’s Center for Innovative Care. “We have already proven we can make a difference in sepsis by intervening quickly and using Mercy’s telemedicine capabilities.”
The program currently in place in St. Louis will be expanded via telemedicine, creating a virtual sepsis unit for more than 300 communities Mercy serves in Arkansas, Kansas, Missouri and Oklahoma. Mercy recently submitted a grant proposal on sepsis management to the National Institutes of Health to assist in establishing a virtual sepsis unit and studying the outcomes.
Once in place, the virtual unit will assist in building sepsis protocols into Mercy’s integrated electronic health record which will red flag patients at risk, define daily treatments and monitor whether treatment is being followed. In addition, Mercy SafeWatch will run algorithms alerting staff to patients at risk for severe sepsis or septic shock.
“This is another gigantic step forward in developing innovative initiatives to improve the health and lives or our patients,” says Lynn Britton, president and CEO of Mercy. “We began implementing an electronic health record almost a decade ago and because of that, we now have the ability to optimize patient data. This is about better care for all patients.”
Mercy includes 31 hospitals, 300 outpatient facilities, 38,000 co-workers and 1,700 integrated physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas.