New Jersey saved nearly 400 patients from dying of sepsis, an elusive but deadly infection, last year. The reason: a collaboration among dozens of hospitals and other healthcare organizations and their efforts to share diagnosis data, treatment protocols, and lessons learned.
Working together under the leadership of the New Jersey Hospital Association, the group was able to dramatically reduce the occurrence of sepsis, a systemic infection that can trigger inflammation and major organ failure. This effort also drove down the state’s sepsis mortality rate by nearly 11 percent, setting the coalition well on its way to reaching its final goal of a 20 percent reduction in patient deaths.
The findings — which the hospital association will post online early Tuesday, to coincide with World Sepsis Day — are good news for hospital patients, elderly people, or those with weakened immune systems who are more likely to contract the infection. The results also demonstrate the importance of cooperation among healthcare facilities that are traditionally competitors, observers said.
There is also a wider public benefit in that reducing sepsis can cut the cost of healthcare over time. Treating sepsis cost nearly $24 billion in 2013 and accounted for more than 6 percent of all hospital spending, according to national figures cited by the NJHA.
“This collaboration among health care providers demonstrates a continued commitment to quality improvement,” noted state Health Commissioner Cathleen Bennett. “A nearly 11 percent reduction in mortality shows substantial progress in just one year.”
One reason sepsis is so challenging is the difficulty in diagnosing it, experts said. The infection can often appear flu-like, with symptoms that include shortness of breath, fever, chills, discomfort, confusion, and discolored skin. While it is not limited to hospital settings, patients in recovery are particularly susceptible to it. Severe sepsis, or septic shock, causes death in 28 to 50 percent of patients nationwide.
“It almost cried out for us to be addressed,” said NJHA executive director Betsy Ryan, who spent 13 days in hospital – and another ten on intravenous antibiotics at home – after she contracted sepsis following an emergency appendectomy several years ago. “I’m proud of what we’ve done, but more work continues.”
The lack of detailed data on sepsis cases, screenings, and treatments was one reason the hospital association sought to form the New Jersey Sepsis Learning and Action Collaborative in 2014. But it also sought to bring awareness to the disease, which is relatively unknown, despite its high morality rate and costly impact.
The data-sharing aspect of the project was “invaluable,” explained Kerry McKean Kelly, who heads communications for the NJHA. “That allowed us to establish a baseline for New Jersey,” she said. “Unlike a lot of other quality indicators, there’s no good single reliable place … for national sepsis mortality rates.”
The NJHA turned to its Institute for Quality and Patient Safety, a collaborative effort formed nearly 15 years ago that has brought together hospital leaders and national experts to successfully reduce bloodstream infections, pressure sores, and other hospital-related complications. A total of 73 facilities agreed to participate in the project, which was based on a model developed by the national Surviving Sepsis campaign.
Surviving Sepsis identified a “bundle” of treatments that work in combination effectively to treat the disease within the first few hours. Success also requires a clear protocol for when patients are screened and knowledge of what indicators to monitor.
The first step of the collaborative project was to collect additional data on sepsis rates: what hospitals had outbreaks; how mortality differed by race, ethnicity and other factors. Other details were collected to help participants identify patterns. Facilities than worked with experts to implement the bundled treatment protocol, which includes specific steps – including administering blood tests, antibiotics, and extra fluids – to be taken three hours and six hours after a patient is flagged for possible sepsis. Tracking outcomes and sharing lessons learned is also a critical part of the process, NJHA said.
At the start of the project in 2014, one in five participating hospitals used screening tools in all units and four in ten had a hospital-wide protocol for addressing sepsis, once discovered, NJHA found. By 2015, 70 percent had screening processes and 90 percent had treatment protocols. Several members also adapted a specific tool-kit to help rehabilitation centers and long-term nursing facilities deal with the infection.
Going forward, NJHA said the group plans to continue working together to further reduce New Jersey’s sepsis mortality rate – now at just over 25 percent – and identify other ways to reduce hospital readmissions from the disease. The group will also explore how to ensure hospitals are properly reimbursed for bundled treatments and how to develop a sepsis screening and treatment plan specific to pediatrics.