Through accountability and teamwork measures, a New York health system has reduced sepsis metrics and nonrisk-adjusted mortality for septic shock by 50% over a five-year period.
As of mid-2023, Northwell Health had achieved a 12% mortality rate.
“Sepsis awareness, early identification and prompt treatment continue to be our focus,” said Isabel Friedman, DNP, RN, Northwell Health’s principal for process improvement in its Department of Clinical Transformation. She also serves as the nursing chair for Northwell’s sepsis and advanced illness collaborative.
An internal faculty of subject-matter experts support this systemwide collaborative by providing evidence-based updates and helping with the educational agenda.
“Accountability for sepsis care rests with our senior executive sponsors and flows systematically down to the sepsis team. These teams are the boots on the ground heroes at the sites,” Friedman said in the second in a webinar series on the Centers for Disease Control and Prevention’s Hospital Sepsis Program Core Elements.
The CDC guidance can help health care facilities implement, monitor and optimize their sepsis programs and outcomes. This free continuing education webinar series was developed in collaboration with the AMA and CDC’s Project Firstline.
The CDC estimates that about 1.7 million adults in the U.S. develop sepsis annually, with 350,000 dying from the infection. About 73% of U.S. hospitals have a sepsis program, but only 55% dedicate time for sepsis program leaders. Just over half involve the hospital's antibiotic stewardship program, said Ray Dantes, MD, medical adviser for CDC’s Division of Healthcare Quality Promotion.
Accountability matters
Presenters in the webinar focused on two of the CDC’s seven core elements—accountability and multiprofessional expertise—that offer a blueprint for hospitals looking to build a successful sepsis program.
One of the elements, accountability, has two big pieces, said Hallie Prescott, MD, associate professor of pulmonary and critical care medicine at the University of Michigan, and a staff physician at the Ann Arbor Veterans Affairs Healthcare System. The first is designating one or two dedicated leaders for the hospital sepsis program. Secondly, the hospital sepsis program should be setting definable goals and reevaluating those goals each year.
Identifying a single physician leader to take on responsibility for sepsis program management and outcomes is an example of “accountability,” said Prescott.
Because sepsis can happen anywhere throughout the hospital, it’s also important to engage multiprofessional expertise, added Dr. Prescott.
This means appointing a sepsis coordinator who oversees day-to-day implementation of hospital sepsis program activities, and fostering collaboration across key hospital locations, such as the emergency department, the hospital wards, and the intensive care units. Teams should include nursing, emergency medicine, critical care, hospital medicine and other primary hospital services, such as infectious disease, pharmacy and social services.
At Henry Ford Jackson Hospital in Michigan, the sepsis leadership team sets yearly goals to review data and ensures the electronic medical record is sepsis-friendly.
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The team reports its Severe Sepsis and Septic Shock Management Bundle (SEP-1) data “every month at this meeting,” said Colleen Drolett, RN, HMS, the hospital’s sepsis nurse abstractor. “We review how we compare to other hospitals in our system, and at the state and national levels, and we discuss our successes and our challenges related to the SEP-1 bundle.”
Driving down sepsis death rates
Corewell Health West, a group of 11 hospitals in Michigan, found itself in a rut in the last decade. Mortality rates stagnated at 27%, said Nicholas Kuhl, MD, system emergency services medical director at Corewell Health West.
With a renewed focus on sepsis care, leaders there decided it was time to hire a sepsis coordinator and set a goal of reducing sepsis mortality by 20% in the first year. The health system recruited the medical directors of the medical intensive care unit and emergency department to the sepsis team. These physicians had protected time for this initiative and worked with the newly hired nurse sepsis improvement specialist to oversee the emergency department, hospitalists and acute care surgeons, and collaborate with the intensive care unit to achieve this goal.
“We built in a weekly cadence where we could review every single case that came in that prior week—both the ER cases and the hospital-identified cases. Our coordinator would sit down with me, and we'd go over this in detail,” Dr. Kuhl said.
The health system created a rapid-improvement event to determine criteria for which cases would be defined as a code sepsis and how to locate them, “even at triage,” Dr. Kuhl said.
Through these multiprofessional efforts, “we’re proud that mortality has stabilized at about 10%,” he said.
