SEPSIS: Recognition at Last?
State Adopts Standardised Care Rules
There have been some encouraging results in the fight against sepsis: Recent data published in the Lancet shows that adherence to the current SSC guidelines, including early goal-directed therapy, has been proven to impact mortality and outcomes for patients with this severe condition.
However, unlike other conditions, such as cancer or heart disease, public awareness of sepsis and its serious consequences is very low. This continues to be one of the most frustrating facts for intensive care practitioners in their fight against the condition, which claims as many lives annually as heart attacks. More recognition of the condition would assist clinicians’ early identification, treatment and ease the need for complex explanations of symptoms to patients and families. We realise the effects that early, protocolised care can have on outcomes for patients with sepsis, but strict adherence to guidelines, and across-the-board standarisation of care is far from a reality. Support from many levels of healthcare and public organisation is still lacking in many areas.
Is the tide changing?
In his recent State of the State address, Governor of the State of New York, Andrew Cuomo outlined his healthcare vision that New York would set the “Gold Standard” for patient care in the United States. He detailed precedent-setting plans for the State to require hospitals to apply and evidence-based protocol for the early indentification, management and treatment of sepsis, as well as to publicly report protocol adherence rates, sepsis rates and risk-adjusted mortality.
The announcement of these initiatives was prompted largely by the case of Rory Staunton, a 12-year-old boy who died of severe septic shock after being sent home from the emergency room at a New York medical centre last year.
Rory’s parents did not realise that the results of blood tests ordered for their son had not come back at the time he was discharged. Those results suggested that he could be critically ill, but the Stauntons learned about them only when they received a laboratory bill after Rory’s death. This highly publicised case caused statewide attention to be drawn to the dire results of untreated sepsis – attention that reverberated inside the upper levels of political office.
Governor Cuomo’s commitment to address this important public health issue in such an open and practical way gives us hope within the field that all of our efforts to advocate on behalf of patients have had some widespread impact. As he rightfully noted in his speech, we must work together to promote best practice against sepsis, a serious medical condition that ranks as the number one cause of death in U.S. hospitals. For those who survive, the after effects of sepsis can be life altering (e.g. limb disfigurement, organ dysfunction such as respiratory distress or kidney failure) and expensive – accounting for an estimated $17 billion annually in national healthcare expenses.
“We can reduce the catastrophic deaths, life-altering consequences, and high costs of sepsis only by ensuring that hospitals act quickly to diagnose sepsis and begin treatment within the “golden hour” when it can be most effective,” says Governor Cuomo. “It’s not that we don’t know how to treat sepsis, but that appropriate treatment is not being given quickly enough in all cases.”
“The Gold Standard”
Governor Cuomo will enact the following recommendations:
- Establish a process for screening patients in all hospital settings to facilitate early recognition of patients with possible sepsis;
- Commence a countdown clock once possible sepsis has been documented; and
- Establish clear time-based goals for providing treatment once sepsis has been identified: aiming for administration of antibiotics within one hour and full protocol implementation within at least 6 hours.
The evidence shows and experts agree that successful adoption of these procedures at all hospitals would save lives and, for those who survive, reduce the severity of their injuries.
Sepsis – A tough opponent
In a bid to battle one of the most insidious conditions patients in the ICU encounter, ESICM has been tirelessly involved with scientific study and research into the physiology and treatment of sepsis and sepsis-related conditions. Over the last decade, the Society has founded a scientific section focused on systemic inflammation and sepsis, organised several task forces and working groups on the condition.
Surviving Sepsis Campaign (SSC)
Our Executive Committee has taken a leadership role: President Jean-Daniel Chiche, Past President Andrew Rhodes and Research Chair Richard Beale spearheaded the Surviving Sepsis Campaign at our annual congress in Barcelona in 2002, and have been integral in the development of the sepsis management guidelines. To further improve effectiveness and adherence, ESICM has taken a central role, alongside SCCM to update these guidelines, published in the February 2013 issues of Intensive Care Medicine and Critical Care Medicine and will work to promote the use of these SSC 2012 guidelines in the coming months.
ESICM will also bring experts from the field together to hold a regional conference in Montreux, Switzerland July 4-5:“Sepsis from Bench to Bedside”. This conference will delve into the current state of the scientific research, and challenges clinicians face in the practical treatment of patients with severe sepsis and septic shock.
An important step forward
If New York moves forward with these plans, it will be the first U.S. state to require all hospitals to adopt best practices for the early identification and treatment of sepsis. Governor Cuomo says he will indeed direct the Department of Health to propose regulations that will require every hospital in New York State to identify and implement a sepsis recognition and treatment protocol.
Additionally, he noted that they will require procedures to be set out to address the differing treatment standards of both adults and children and will instruct all staff with direct patient care responsibilities (as well as key staff like laboratory and pharmacy technicians) to be trained on these protocols. In his plans, the Govenor notes that all available data on implementation and effectiveness will be collected and shared, in order to ensure oversight and facilitate continuing research.
It is estimated based on current statistics, that statewide adoption of effective anti-sepsis protocols in New York could save 5,000 to 8,000 lives per year and reduce other tragic and costly consequences of sepsis.
This move by Governor Cuomo and New York State is indeed an encouraging one in the fight against sepsis. As this is a condition that can and does affect patients in every centre of the world, ESICM and other scientific organisations who have been consistent in their battle with this condition can only hope that other states and regions join the fight by replicating this model and initiating their own standardised care practices.
Sherry Scharff, Editorial & Publications
Link – Surviving Sepsis Campaign: International Guidelines for the Management of Severe Sepsis and Septic Shock: 2012<Back to the news list