Garden State Seeks to Regulate Hospital Protocols for Sepsis

Lilo H. Stainton | June 21, 2017 | Health Care
Despite sharing of diagnostic data and best practices, sepsis mortality rates are on the rise in New Jersey

New Jersey could become one of a handful of states to require hospitals to follow strict protocols for addressing sepsis, an extreme reaction to infection that can lead to tissue damage, organ failure and — for nearly one in three patients here — death.

The state Department of Health has recommended changing the infection-control regulations that pertain to hospitals to mandate that they adopt evidence-based protocols and train staff to quickly identify and treat various levels of sepsis, officials announced Monday. Sepsis, or blood poisoning, can result from any type of infection, but long-term damage can be avoided with proper treatment.

Since medical knowledge of sepsis continues to evolve, the DOH declined to outline specific requirements in its proposal. Instead, the rule would mandate that hospitals — the most common sites of sepsis cases — identify best practices in place elsewhere and use these as a guide to develop their own systems. Public comment on the proposed rule change will be accepted through August 18.

Sharing lessons learned

Most Garden State hospitals are already well on their way to meeting such a proposal. Dozens of facilities have been working together for several years, with help from the New Jersey Hospital Association, to improve sepsis outcomes by sharing diagnostic data, treatment protocols, and lessons learned. The collaboration has driven down the sepsis mortality rate by 13 percent among participating hospitals, according to the NJHA, saving hundreds of lives annually.

“We’ve made some great strides,” said Shannon Davila, a nurse who is the director of the NJHA’s Institute for Quality and Patient Safety, which was formed 15 years ago to address crosscutting issues like sepsis. Some 90 percent of facilities now have sepsis protocols in place, she said, compared with about 40 percent when the project started in 2014.

“For us, more than anything, (the rule proposal) validates the great work our hospitals have been doing,” Davila said.

Mortality rates climbing

But sepsis still kills nearly 2,000 Garden State residents a year and the state’s overall sepsis mortality rate has been on the rise since 2011, the DOH reported; in fact, New Jersey’s sepsis death rate is 1.5 times that of the nationwide norm. Health commissioner Cathleen D. Bennett decided that the Garden State could do better.

“While sepsis protocols have been an increasing focus of New Jersey hospitals, we know early identification and prompt treatment of sepsis is critical to survival,” said Bennett, who has made public health and prevention a priority during her tenure. “Every minute counts. Sepsis is treatable if addressed as a medical emergency.”

The condition can be hard to diagnose — or to distinguish from symptoms of the underlying infection — but treatment with antibiotics can be extremely effective, when the drugs are administered as soon as possible. (The vast majority of patients who develop sepsis have an underlying health condition, so maintaining health and preventing infection is critical in avoiding sepsis, according to the federal Centers for Disease Control and Prevention.)

New York State was the first to mandate that hospitals adopt sepsis protocols; Illinois followed suit three years later, and Wisconsin and Ohio have implemented voluntary provisions, the CDC notes. The issue is also a priority for several national healthcare quality groups, including a panel that weighs in on Medicaid and Medicare.

Leading cause of hospital deaths

While sepsis is the top cause of hospital deaths nationwide — and the most costly condition these facilities address — hospital systems that have focused on improving outcomes have shown “remarkable and replicable results,” according to the Rory Staunton Foundation For Sepsis Prevention, which pushed for the New York law and is now working to implement state-based policies nationwide.

Personal stories regarding the impact of sepsis have also affected Bennett, who met with Ciaran Staunton, Rory’s father, in 2014. His son died after a scrape he suffered in a basketball game became infected and medical professionals failed to diagnose and treat the resulting sepsis in time. Bennett also talked with a 32-year-old Gloucester County woman who ended up temporarily paralyzed after an infection caused by a kidney stone grew into sepsis.

In conjunction with the proposed rule change, the DOH plans to launch a public education campaign to increase awareness of sepsis among the public. Many are not aware of the condition and its dangers, and patients need more information so they can ask healthcare professionals, “Could it be sepsis?”

The NJHA sepsis project has also focused recently on developing tools to help hospitals better engage patients and family members in the effort to improve sepsis outcomes, the NJHA’s Davila explained. The group produced brochures, videos, and other materials for hospitals to share with visitors concerned about the condition and is working with nursing homes and other long-term health providers to reduce hospital re-admissions related to the condition, she added.

The NJHA sepsis collaboration will be the focus of an annual member-education event in September, Davila said; the NJHA institute has been asked to lead a national hospital focus group with more than 4,000 members devoted to reducing sepsis.

“I think hospitals (in New Jersey) are in a great position,” she said, with protocols for screening and treatment in place at most. The declining number of occurrences of sepsis at these facilities is one of several patient safety indicators that suggest the Garden State’s efforts are paying off.

The DOH’s proposed rule change would require hospitals to “establish, implement and periodically update” proven protocols to quickly identify and treat patients with sepsis, or the more dangerous form of septic shock. It would require hospitals to train certain staff in these protocols by a specific date and to document this education process.

“Sepsis is treatable if addressed as a medical emergency. Early identification and prompt treatment of sepsis is critical to survival,” the proposed rule states. “Recent studies and quality-improvement initiatives demonstrate that the single most-important factor in reducing mortality and morbidity from sepsis is early detection with timely administration of treatment.”

“To the extent sepsis can be avoided or its impact minimized, sepsis unnecessarily compounds the economic burden on the available resources to care for the State’s growing aging population, and correspondingly reduces the resources available to serve persons of all ages who are disabled for reasons other than sepsis,” the proposal continues.

As models for sepsis protocols, the DOH recommended several sources for hospitals seeking to develop their own evidence-based guidelines, including the Surviving Sepsis Campaign that served as a blueprint for the NJHA collaboration, the Hospital Improvement Innovation Network, and the National Quality Forum.