CDC’s alarms about sepsis crisis in the community join recent high-profile sepsis-related celebrity deaths (including Mohammad Ali and Patty Duke), a rising threat, and Sepsis Awareness Month in September
The U.S. Centers for Disease Control and Prevention (CDC) has made sepsis-prevention a major focus in recent news cycles, and home care providers in New York State have been working to meet this deadly health care crisis head-on, using a first-in-the-nation, community-based screening tool piloted by the Home Care Association of New York State (HCA) in partnership with clinicians and quality improvement experts from IPRO and Sepsis Alliance, who have long raised the issue of health care’s sepsis crisis.
As the CDC reported in a major media outreach campaign in late August, 72% of people who contract sepsis – an extremely life-threatening, often-fatal bodily response to infection – got the illness even though they had recently been seen by practitioners, signaling a missed opportunity for urgent treatment and intervention.
Meanwhile, estimates suggest that as much as 80% of sepsis cases occur in the community or in an individual’s home, not just in hospitals where most people are familiar with sepsis occurrence. In New York State, the number of sepsis cases rose 68% from 2005 to 2011. Sepsis is also the single most expensive condition nationwide and the number-one driver of hospital readmissions in New York State. (See the end of this press release for more sepsis facts and resource links.)
“Well before the recent CDC alarm bells on sepsis, and prompted by compelling data and outreach by Sepsis Alliance, HCA mobilized to explore a possible significant role and impact by home care providers in combatting this serious problem,” said HCA Executive Vice President Al Cardillo. “As we reached out across the states and to national and medical sector forums for leads, no one at the time was really discussing, much less creating, tools for screening and intervention in sepsis through the home care system. But at every turn, we were encouraged to pursue a home care effort for sepsis and to alert all of our contacts to our progress.”
Sepsis Alliance, the U.S. Centers for Medicare & Medicaid Services (CMS), the CDC, HCA, IPRO, and others are working diligently on a public health and early recognition/intervention strategy to tackle the problem from the home and community-based care angle as well as in other health care settings.
“CDC Director Thomas Frieden has made clear how vital it is for the public to know that sepsis is not just a hospital condition but a top-priority risk that we all need to be aware of. Sepsis can strike anywhere and anybody,” Cardillo added, noting Sepsis Alliance’s reported data that less than half of people have even heard of the fatal condition now being elevated as an urgent risk by CDC officials.
“Home care providers in New York State have routine, often daily interactions with 400,000 patients per year, many of them very sick, chronically ill or frail elderly,” Cardillo said. “These patients are receiving follow-up care after delivering babies or after hospital surgery, or have conditions susceptible to infection, regardless of whether they’ve entered a hospital or not. Home care’s routine patient interaction makes in-home nurses a powerful force in combatting the sepsis health care crisis – a crisis that presents itself at home or in community settings even more regularly than in hospitals, even though most of the focus on sepsis-prevention has been directed at hospital care.”
Recognizing the power of home care providers to deliver interventions for this major public health threat, HCA partnered with quality improvement experts at IPRO, Sepsis Alliance, doctors, home care providers, and others to develop, pilot and support a screening tool and provider protocol that home care clinicians can use to identify the risk of sepsis, treat infections at home if appropriate, and refer patients for higher-level hospital care if certain risk criteria are presented that require immediate action. HCA is working closely with IPRO and Sepsis Alliance to present this new tool and protocol, and provide guidance and training to launch it on a statewide, voluntary basis for home care clinicians sometime in late September.
The home care sepsis screening tool is currently incorporated as part of a federally funded sepsis intervention effort already being led by IPRO, New York State’s Medicare quality improvement organization. The project is being conducted in partnership with HCA, Sepsis Alliance and the Rory Staunton Foundation for Sepsis Prevention.
“Sepsis is a fast-moving illness that can affect virtually anyone suffering from infection. Mortality from sepsis increases 8% every hour that treatment is delayed. As many as 80% of sepsis deaths may be prevented with rapid diagnosis and treatment,” said Sara Butterfield, IPRO’s Senior Director, Health Care Quality Improvement. “IPRO is engaged in a project funded by CMS to facilitate educational opportunities to increase awareness of the signs and symptoms of sepsis among pre-hospital health care providers and the public within the Albany and Syracuse hospital referral regions. This effort, which we expect to expand upon in future quality improvement projects, incorporates several components, including our work with HCA on the development and piloting of a sepsis screening tool that holds major promise for tackling this crisis in non-hospital settings.”
Sepsis Alliance, founded in 2007, has taken the lead on sepsis awareness efforts over the past ten years, and is in the vanguard of education and public awareness efforts on the crisis.
“Sepsis is not an infection itself, but the body’s response to infection, and it can very quickly lead to septic-shock and organ failure – within a matter of hours – if it is not promptly detected and treated in an appropriate setting,” said Sepsis Alliance Executive Director Thomas Heymann. “We have long understood that this is a public health crisis which is not restricted solely to hospital settings, as the incidence of community-derived sepsis has reached alarming levels in New York State and nationally. Home care can make a major contribution in the public-health response through education, screening, early identification and intervention with medical partners.”
How the sepsis tool works
The home care sepsis screening tool (known as the Home Care Services Adult Sepsis Screening – SBAR Form) is designed as a series of question prompts, first instructing clinicians to consider whether a patient’s medical history, physical examination or findings suggest an infection; it also asks the clinician to check off certain other systemic criteria of sepsis risk, such as fever or hypothermia, a heart rate or pulse above 90 beats/minute, respirations above 20 breaths/minute, pain, altered mental status, or paleness.
Depending on the clinician’s answers to these questions, he or she can determine whether a baseline level of sepsis risk is present or whether to check for some additional warning signs related to lung, kidney or cardiovascular functions. The screening tool uses all of these patient-specific response criteria in an algorithm that determines whether the patient meets the criteria for sepsis or severe sepsis.
A series of interventions are then advised, from a lower-risk intervention of patient education about sepsis to the more severe end of the spectrum, with instructions stating that the patient has met the criteria for potential sepsis or severe sepsis, and requires immediate intervention in consultation with the physician and other medical/emergency medical partners.
Amy Bowerman, RN, Director of Quality Management/Privacy Officer at Utica-based Visiting Nurse Association of Utica and Oneida County of the Mohawk Valley Health System, has been HCA’s clinician lead on fashioning the tool in conjunction with clinicians in HCA’s Quality Committee and physician experts in sepsis, like Dr. Steven Simpson of the University of Kansas and Dr. Martin Doerfler of the Northwell Health System. “This efficient, highly-focused screening tool provides an assessment of the critical factors that would point to infection and potential sepsis risk, combined with a follow-up intervention component, offering specific instructions based on the clinician’s response to certain elements,” Bowerman says. “Home care’s use of this tool holds incredible promise in tackling a major cause of morbidity, fatalities and health care costs.”
Bowerman, a clinician in both acute-care hospital and home care settings, helped fashioned the tool in a way that was compatible with the new protocols also applied in hospitals to help ensure its alignment with other new developments in the system.
More Information: What is Sepsis?
- Sepsis is an inflammatory response to an infection, often with fatal results.
- Sepsis is a medical emergency. Sepsis can cause organ failure, septic shock, a precipitous drop in blood pressure – and death.
- Older adults or people with weakened immune systems are most susceptible, but anyone can develop sepsis from an infection.
- Treatment usually includes antibiotics and large amounts of intravenous fluids.
Please consult the following additional resources for more sepsis facts and data.
- Sepsis Alliance information: http://www.sepsis.org/
- Rory Staunton Foundation: https://rorystauntonfoundationforsepsis.org/
- IPRO Community Based Sepsis Initiative: http://www.stopsepsisnow.org
- “Making Health Care Safer. Think sepsis. Time matters.” (a CDC Vital Signs Report): https://hca-nys.org/wp-content/uploads/2016/09/2016-08-vitalsigns.pdf
- “Sepsis Fact Sheet” (Courtesy of Sepsis Alliance): https://hca-nys.org/wp-content/uploads/2016/09/2016_sepsis_facts_media.pdf
- Harnessing Home Care in Early Sepsis Recognition (Guest Article by HCA on the CDC website): https://hca-nys.org/wp-content/uploads/2016/09/CDC-Article-Harnessing-Home-Care-in-Early-Sepsis-Recognition.pdf
Roger L. Noyes (518) 275-6961 (cell); (518) 810-0665 (office)