USA Today: ‘Rory’s Regs’ On Sepsis Require Hospital Checklists, Save Lives

USA Today, Sepsis, Rory Staunton Foundation, Rorys Regulations

By Jayne O’Donnell
Published by USA Today, May 22, 2017

New York regulations named after a 12-year-old victim of sepsis increased the chance of survival from the potentially deadly condition, a study out Sunday shows.

“Rory’s Regulations,” named for the late Rory Staunton of New York City, requires hospitals to quickly perform a checklist of safety measures when people show up at hospitals with sepsis.  A report in the New England Journal of Medicine Sunday found the faster hospitals completed the checklist of care and administered antibiotics, the lower the risk of death in hospitals from sepsis. With each additional hour it took, the risk of death increased 4%.

Sepsis, which occurs when the body’s response to an infection injures its own tissues and organs, is the biggest killer of hospital patients. More than 1.5 million cases of sepsis occur in the U.S. annually and more than 20% of people who contract sepsis die from it.

Rory Staunton died five days after falling and getting a cut on his arm in his school gym.

“This is an amazing policy that happened,” says University of Pittsburgh medical school assistant professor and physician Chris Seymour, lead author on the study.

“Minutes matter, and it is critical to perform the correct tests and get the patient antibiotics as fast as possible,” said co-author Mitchell Levy, a physician and professor at Brown University’s medical school.

Ciaran Staunton, Rory’s father, says he seldom uses this word but calls the findings “huge.”

“I have met a lot of the families saved in New York because they had to rule out sepsis,” says Staunton. “I’ve been to the grave sites in other states where there were no protocols.”

Read the original story on USA Today here.

CBS News: Aggressive treatment for sepsis can save lives, research shows

CBS News, Rory Staunton Foundation, Rory Staunton, Sepsis, Ciaran Staunton, Rorys Regulations, Sepsis Awareness, Sepsis, research

WASHINGTON — Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn.

Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down.

New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.

Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.

That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.

“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”

The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.

To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?'” advised the CDC’s Dr. Lauren Epstein.

Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.

It strikes more than 1.5 million people in the United States a year and kills more than 250,000.

Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.

In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.

If you think you have an infection that’s getting worse, seek care immediately, Epstein said.

Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.

Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.

Sepsis is most common among people 65 and older, babies, and people with chronic health problems.

But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.

Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.

“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.

 

http://www.cbsnews.com/news/sepsis-syndrome-aggressive-treatment-saves-lives/

Stat News: Sepsis can send a child to the brink of death within hours

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Sepsis can send a child to the brink of death within hours. A new coalition of hospitals is fighting back

 

By Charlotte Huff
Published by Stat News, April 27, 2017

 

FORT WORTH, Texas — It might start out looking like not much more than an ordinary childhood fever.

But within days — within hours, sometimes — the complication known as sepsis can turn deadly. The patient’s blood pressure dives. Intense pain floods her body. Her organs begin to shut down.

The toll is frightening: Sepsis hospitalizes some 75,000 children and teens each year in the United States. Nearly 7,000 will die, according to one 2013 study. That’s more than three times as many annual deaths as are caused by pediatric cancers. And some of the children who survive sepsis may suffer long-term consequences, including organ damage and amputated limbs.

Now dozens of hospitals nationwide, including here in Fort Worth, are launching an all-out campaign against sepsis, an infection-related complication which can take hold after a viral illness — or an injury as innocuous as a scraped arm or a bug bite. Their ambitious goal: Reduce both childhood sepsis deaths and diagnoses of severe sepsis at participating hospitals by 75 percent by the end of 2020.

“You go big or you go home,” said Amy Knight, chief operating officer for the Children’s Hospital Association, which organized the sepsis collaboration.

The 44 hospitals participating in the effort so far — more are likely to join — have agreed to implement diagnostic and treatment protocols developed by dozens of experts. They will, for instance, screen all patients who show any signs that could be associated with sepsis and treat potential cases with quick infusions of antibiotics and intravenous fluids. And they’ll submit data on their cases to the collaboration — including how fast they got patients into treatment — in hopes of identifying best practices.

Some hospitals are also working on public education, such as teaching the warning signs of sepsis to parents of cancer patients, who are especially vulnerable to infection.

One key challenge: Training physicians and nurses to more quickly recognize the earlier stage, known as “warm sepsis,” which can masquerade as many other more common and far less worrisome childhood ills.

A child might develop a fever and a somewhat faster heart rate, but otherwise has good color and is chatting with the doctor. “And 10 minutes later, their blood pressure is out the bottom and they are in dire straits,” said Dr. Joann Sanders, chief quality officer at Cook Children’s Health Care System here in Fort Worth. “A kid who is well into sepsis is not that hard to recognize. That warm sepsis kid — that’s your challenge.”

A terrifying brush with death

Sepsis moved with terrifying speed in the case of Chloe Miller, who was diagnosed with septic shock last fall at age 12.

Chloe had gone to school near her home in Silver Spring, Md., that Friday with no signs of illness, although the teachers reported that she seemed somewhat tired, recounted her dad, Mark Miller. Her parents have learned to stay particularly attuned to even subtle changes in Chloe, who has autism and a seizure disorder and can’t communicate verbally.

By Saturday, the preteen was running a fever of 104 degrees. Acetaminophen did bring it down. But she was sleeping for long stretches, and becoming increasingly difficult to wake up. Alarmed, Chloe’s mother and grandmother decided to take her to a local emergency room late Saturday. They nearly had to carry her to the car.

The doctors and nurses there moved quickly, diagnosing Chloe with pneumonia and influenza and giving her antibiotics, intravenous fluids, and an escalating flow of oxygen for her alarmingly low blood pressure and oxygen readings, said Dr. Christiane Corriveau, the critical care physician who treated Chloe once she arrived by ambulance at Children’s National Medical Center in Washington, D.C., in the wee hours of Sunday morning. “I think everybody was concerned that this was more than just pneumonia — that her body was being taken over by the infection,” she said.

“When they said, ‘She’s out of the woods,’ it really hit me just how life-threatening this was.”
Mark Miller, parent

Despite the aggressive treatment, Chloe was already entering the final and most life-threatening stage of sepsis, called septic shock.

Miller distinctly recalls how unresponsive his daughter was in the intensive care unit, not flinching when she got a shot or an intravenous line. Also, that her breathing was unnervingly fast: “In and out and in and out and in and out.”

After getting blood and platelet transfusions, antibiotics, fluids and heart medications, among other treatments, Chloe was improving by Monday, Corriveau said. By Tuesday, her breathing had eased and her “blood pressures were beautiful.”

Miller, who works at Children’s National in a fundraising role, recalls lots of updates as clinicians combated his daughter’s low blood pressure and other symptoms. But it wasn’t until the worst of the crisis had eased that he first heard the word “sepsis” and learned what that diagnosis meant.

“When they said, ‘She’s out of the woods,’ it really hit me just how life-threatening this was,” he said.

A simple screening that can save lives

Sepsis, sometimes called blood poisoning, describes the body’s massive inflammatory response to an infection that infiltrates the blood stream. The body marshals all its efforts to protect the heart, lungs, and other vital organs, said Dr. Charles Macias, an emergency physician at Texas Children’s Hospital in Houston and one of the collaboration’s co-chairs.

A child’s heart rate typically increases, in order to pump more blood to boost oxygen levels to organs and other tissues, Macias said. The increased demand for oxygen speeds up his breathing. Blood pressure can drop, as some vessels may leak and others may dilate.

In 2012, a 12-year-old New York student named Rory Staunton developed sepsis and died several days after cutting his arm while playing basketball, heightening national attention to the issue. A few states, including New York, have since enacted protocols mandating that hospitals regularly screen patients for sepsis.  The Illinois version is dubbed Gabby’s Law, after a young girl who died from sepsis following a tick bite.

Some screening steps can be quite simple.

At Cook Children’s, a nurse will press down firmly on the child’s skin, for three seconds, said Stephanie Lavin, the hospital’s nurse quality leader for the sepsis initiative. The skin naturally turns lighter. But it should return to a normal shade within three seconds of releasing that pressure, she said. Any signs of poor blood flow — the jargon is capillary refill — indicates that the child is dehydrated or that blood has begun to shift away from the skin’s surface.

That skin check is part of Cook Children’s 18-point sepsis screening, a process that doesn’t take much longer than a minute and includes asking parents if their child has shown any signs of confusion. The screening is performed with any emergency room patient who complains of a fever or another symptom that could signal an underlying infection, such as abdominal pain.

Any child who scores 5 or higher on the 18-point scale gets oxygen, antibiotics, and intravenous fluids — even before the blood test results come back, according to Lavin. That turns out to be a lot of patients: About 150 to 190 a month in the ER are identified by that initial screen as potentially having sepsis.

Regular screening already is routine in some other departments, such as the surgery and cancer units. Beginning this spring, it will be expanded to nearly every unit of the hospital, Lavin said.

Some of the collaboration’s participants, including Cook Children’s, have already had been participating in smaller initiatives against sepsis. Other hospitals can join the national effort; the next deadline to sign up is June 30.

Rory’s mother, Orlaith Staunton, applauds the collaboration’s efforts. But she still advocates for a more standardized regulatory approach: She wants to require every hospital in the US to adhere to certain screening and treatment procedures.

Imagine, she said, that you’re driving down the road with an ill family member in the car. “This hospital happens to be very good at enforcing their own sepsis protocols. This one is not so good. I end up driving into the wrong hospital. Worst-case scenario, my child or my loved one dies,” said Staunton, who cofounded the Rory Staunton Foundation with her husband.

But Knight believes that the national collaborative model will work best, because it lets medical experts learn from one another. At Cook Children’s, for instance, doctors and nurses continue to tweak their screening system, in order to most rapidly flag that “warm sepsis” patient.

“Will we bring kids into the hospital and watch them overnight who don’t have sepsis?” asked Sanders, the chief quality officer. “Probably. But I’d rather do that to 90 kids and catch the 10 kids who are in early sepsis, and save their lives.”

 

Read the original Stat News article here.

 

Metro News: This 12-year-old’s death has saved almost 5,000 New Yorkers

Metro News, This 12-year-old's death has saved almost 5,000 New Yorkers, Sepsis, Rory Staunton Foundation, Rory Staunton

By Kimberly M. Aquilina
Published by Metro News, April 17, 2017

Rory Staunton would be in college this year. Instead, his family counts the years without him.

A foundation set up by an Irish family has saved thousands of American lives.

Rory Staunton, 12, cut his arm while diving for a basketball at his private school in New York on March 28, 2012. He died four days later from septic shock.

Sepsis, sometimes referred to as “blood poisoning,” is the result of a massive immune response to a bacterial infection. Sepsis can lead to organ failure, tissue damage and death.

Sepsis kills 258,000 Americans each year, according to the Sepsis Alliance.

After his death, Rory’s parents Orlaith and Ciaran, originally from County Louth, Ireland, established the Rory Staunton Foundation to raise awareness of the dangers of sepsis.

On Jan. 29, 2013, Gov. Andrew Cuomo announced all New York state hospitals would adopt Rory’s Regulations, evidence-based protocols for the early diagnosis and treatment of sepsis.

According to a recent New York State report, “Sepsis Care Improvement Initiative,” patients are being identified and treated earlier — a measure that is saving lives.

“Despite the early nature of this initiative we can demonstrate encouraging improvements,” report authors wrote.

Rory’s Regulations took effect in 2014. Mortality rates from sepsis in New York from the beginning of 2011 through the end of 2015 indicated that 4,727 fewer people died from it, according to the new report.

“We have met the people that have been saved by these protocols,” Ciaran Staunton, Rory’s father, told the Independent.

“We are happy that their parents are not joining us in this miserable life. We want that fighting chance extended to every family in America.”

Ciaran told the Independent that he hopes not for a cure, but for awareness and for all states to pass regulations.

“When our son died, there was no awareness, no sepsis protocols, nothing in the A-Z book on sepsis,” he said. “Now we’ve shown here’s what we can do in New York — we want the U.S. government to have the same level of anxiety and awareness of sepsis as they do Ebola.”

While playing in school on March 28, 2012, Rory scraped his arm in gym class and was patched up by a teacher.

Later, at home, his mother heard him vomiting.

“There wasn’t a huge amount of vomit, but he kept saying, ‘My leg, my leg, Mom,’” Rory’s mom, Orlaith Staunton, told The New York Times. In the morning, Rory’s temperature reached 104.

His pediatrician, Dr. Susan Levitzky, saw him that evening, but dismissed the leg pain saying it was probably due to the fall in class.

“We showed her the cut on his elbow, and I saw her follow up his arm from the cut,” Rory’s mom said. “She said, ‘The cut’s not an issue.’ She focused on his stomach. We said, ‘Although you see him throwing up, that’s not what he’s really complaining about.’ Rory and I both said to her that it’s the pain in his leg that’s really bothering him.”

Rory’s culture for strep came back negative, but his skin was mottled, another “worrisome observation,” an infectious disease specialist not involved in Rory’s care told The New York Times.

Levitzky sent Rory to the emergency room at NYU Langone Medical Center. He was treated for dehydration and sent home, the Independent reported.

Three hours later, the hospital’s laboratory found that Rory’s cell count was elevated, due to his body fighting a bacterial infection, but his parents were left in the dark.

“Nobody said anything that night,” Rory’s mom told The New York Times. “None of you followed up the next day on that kid, and he’s at home, dying on the couch?”

NYU Langone declined comment when contacted by The New York Times.

“Our deepest sympathies go out to the family at this difficult time,” said Lisa Greiner, a hospital spokeswoman.

Read original MetroNews article here.

Times Telegram: New Care Standards Lower Sepsis Death Rate

By
Published by Times Telegram, April 10, 2017.

New York has reduced the number of residents dying of sepsis since new regulations kicked in in 2014, state data shows.

Rory’s Regulations, named after Rory Staunton, 12, of Queens, who died of sepsis after a 2012 fall in the school gym, require hospitals to develop and implement protocols to diagnose and treat sepsis early, the first such requirement in the nation.

The protocols are needed, said Dr. Maria Gesualdo, president of Slocum-Dickson Medical Group and a pulmonary critical care specialist who’s heading up the sepsis initiative at the Mohawk Valley Health System.

“When somebody comes through the (emergency department), there’s a stroke alert,” she said. “We have protocols for myocardial infarction (heart attacks) … but we never had anything for sepsis.”

Sepsis, a dangerous reaction to infection, can progress rapidly, leading to the shutdown of the body’s organs and systems, making early intervention critical. It strikes 750,000 Americans each year, killing 200,000. It is the No. 1 cause of death in the hospital and the 11th leading cause of death overall.

In New York, mortality rates for sepsis among adults fell from 30.2 percent to 25.4 percent from mid-2014 through the end of September in 2016, according to the New York State Department of Health study. And the number of patients diagnosed with sepsis rose 20 percent, meaning hospitals got better at identifying patients, according to the study.

Much of the effort centers around screening all patients with infections to see if they may have or be at risk for sepsis, and the use of two protocol “bundles” for patients with sepsis. A bundle is a group of tests and treatments that all patients matching certain criteria should receive.

The three-hour bundle — care to be delivered within three hours — is to resuscitate patients who are severely septic or in septic shock, Gesualdo said. A six-hour bundle is for patients admitted with sepsis.

It’s not that doctors didn’t already know what to do, but they tended to “piecemeal” their treatments.

“Having it all in one order set, we capture everything,” she said. “We don’t miss any of the important elements.”

At Bassett Medical Center, Rory’s Regulations spurred specific initiatives such as a sepsis work group, an alert system for possible symptoms built into the electronic medical record, a rapid response team for a “coordinated and choreographed response,” and provider and nurse education, including the production of a new training video, said Chief of Medicine Dr. Charles Hyman.

“As a result of the above initiatives, Bassett Medical Center has made considerable progress over the past couple years,” he said. “Our 2016 compliance rate is above that of the (New York state) mean for sepsis protocol.”

That means more patients are receiving the prescribed care — such as a systemic antibiotic within one hour of diagnosis — quickly and fully. And the hospital’s sepsis mortality rate is falling below the state average, Hyman said.

The sepsis initiative has been important to spread awareness of a deadly issue and things are definitely improving, Gesualdo said. But perfect compliance doesn’t happen overnight. “It’s really a big initiative. We still have to iron out some wrinkles,” she said.

“It’s everybody’s responsibility,” she added. “We all have to work as a team. We need that nudging till it becomes knee-jerk response.”

Follow @OD_Roth on Twitter or call her at 315-792-5166.

Read original article here.

CBS Philly: Pennsylvania Considering Statewide Protocols For Hospitals To Treat Sepsis

Conall Harvey

Stephanie Stahl from CBS News in PA interviews young Conall Harvey who survived sepsis when he was four years old in March 2015. Since then his parents John and Christin Harvey and the parents of Emily Aiello, Chris and Krista Aiello, have joined with the National Family Council on Sepsis and the Rory Staunton Foundation to successfully lobby for mandatory sepsis protocols in the State of Pennsylvania. Emily Aiello died tragically at fourteen years of age from undiagnosed sepsis.

Society of Critical Care Medicine: A Critical New Study Shows Sepsis Care Saves Lives and Money!

Rory Staunton Foundation, critical, critical care, society of critical care medicine, sepsis, sepsis protocol

A new study just published in the Journal of the Society of Critical Care Medicine shows that patients who receive aggressive care for sepsis within the first three hours of hospitalization have a much stronger survival rate. This higher survival rate is accompanied by lower costs to the hospital and to the U.S. healthcare system in general.

This is a crucial development because it shows a direct link between mortality and costs. This link to survival and reduced costs provides a very strong, convincing argument for every state to adopt sepsis protocols. The National Family Council on Sepsis and the Rory Staunton Foundation advocate for every State to have mandatory sepsis protocols. We call for all State Health Secretaries and Health Commissioners to implement mandatory sepsis protocols immediately and save lives! This report has confirmed what the Rory Staunton Foundation has been saying all along that not alone do sepsis protocols save lives but they also save tax payers a lot of money.

Dr. Martin E. Doerfler, MD, a member of the Medical Advisory Board of the Rory Staunton Foundation is a member of the team of doctors involved in the study.

To read the full article, please click here.

Ciaran Staunton Addresses the 5th Annual World Patient Safety, Science and Technology Summit

California, Ciaran Staunton, Dr. Konrad Reinhart, National Family Council on Sepsis, Patient Safety Movement, Patrick Conway MD MSC CMS, President Bill Clinton, Rory Staunton Foundation for Sepsis Prevention, Rt. Hon. Jeremy Hunt, sepsis, sepsis advocacy, Vice President Joe Biden, 5th Annual World Patient Safety Summit

Ciaran Staunton represented the voice of a sepsis parent advocate speaking on behalf of the Rory Staunton Foundation at the 5th Annual World Patient Safety, Science and Technology Summit in Dana Point, California on February 3rd-4th. Pictured with him here is Jeremy Hunt, MP, Secretary of State for Health in the United Kingdom and Dr. Konrad Reinhart, an international champion of sepsis and chairman of Global Sepsis Alliance.

This important annual Summit brought together international leaders from hospitals, medical and informational technology companies, patient advocacy community, public policy makers and government officials to discuss solutions to the leading challenges that cause preventable patient deaths.

Keynote addresses at the summit included leading figures in the world of politics and health; President Bill Clinton, 42nd President of the United States and Vice President Joe Biden, 47th Vice President of the United States, Joe Kiani Founder, Patient Safety Movement, Rt. Hon. Jeremy Hunt, MP Secretary of State for Health in the United Kingdom, and Patrick Conway, MD, MSC CMS.

We congratulate The Patient Safety Movement for their tireless efforts to improve patient safety and change the world of preventable deaths.

The Rory Staunton Foundation is the leading sepsis advocacy group in the United States and the National Family Council on Sepsis is the only family driven sepsis advocacy group in country comprising families who have lost loved ones to the preventable death of sepsis. The Rory Staunton Foundation and the National Family Council on Sepsis demand mandatory sepsis protocols in all hospitals throughout the United States.

ABC New 10 Albany – Silent Killer: Local Man Aims To Raise Sepsis Awareness After Surviving Condition

silent killer, Joe Caruso, Rory's Regulations, Albany, N.Y.

A visit by a friend saved this mans live from sepsis and he tells his story to help others, he too thought he could fight the illness because he did not about sepsis. Rory Staunton Regulations in New York State now enforces all hospitals to have sepsis protocols in place BUT you need to get yourself there if you are feeling unwell. Thank you Joe Caruso for sharing your powerful story and thank you IPRO for the work you are doing getting the message out there.

Read the original article here.

Forbes-This Medical Condition Is The Leading Cause Of Unplanned Hospital Readmissions

Forbes, Rory Staunton Foundation, Rory's Regulations, Readmissions, Sepsis, Leading Cause, Unplanned, Robert Glatter MD, unplanned

By
Published by Forbes, January 30, 2017.

Based on a new study evaluating data obtained from the 2013 Nationwide Re-admissions Database, unplanned 30-day readmissions were highest after hospitalizations for sepsis.

Sepsis is a medical condition associated with profound alterations in vital signs, characterized by reduced blood flow to organs, typically triggered by invasive bacterial or viral infections. It is treated aggressively with broad spectrum antibiotics, intravenous fluids, respiratory support, and vasopressors designed to elevate blood pressure when indicated.

But the most unexpected finding from the study was that sepsis represented the leading cause of 30-day readmissions in the U.S. Coupled with this finding, data also indicated that readmissions after treatment for sepsis were also more costly  when compared to readmissions after heart attack, heart failure, pneumonia and COPD.

The study should make hospital administrators and CEOs take a step back to examine this important subgroup of patients when evaluating metrics related to 30-day unplanned hospital readmissions since it accounts for a significant costs related to readmissions.

The Centers for Medicare & Medicaid Services (CMS) has typically evaluated readmissions following index or initial hospitalizations for acute myocardial infarction (AMI) or heart attack, heart failure, COPD, and pneumonia, as part of its pay-for-performance program–but not sepsis.

This study, published as a letter in JAMA online late last week, highlights the importance of examining the proportion and cost of unplanned 30-day readmissions following admission for sepsis.

Dr. Sachin Yende, the lead author from VA Pittsburgh Healthcare System in Pennsylvania, evaluated data from the 2013 Nationwide Readmissions Database.

Data from the study indicated that sepsis accounted for over 12% of more than 1.1 million unplanned 30-day readmissions.  This was significantly more than readmissions after hospitalizations for heart failure (6.7%), or pneumonia (5.0%), COPD (4.6%), and heart attacks (1.3%).

The study also noted that patients with sepsis also carried diagnoses such as pneumonia (7.5%), heart failure (3.4%), COPD (3.3%), and heart attacks (0.7%).

Compared with readmissions following heart attacks, heart failure, COPD, and pneumonia, the length of stay for unplanned readmissions was greater following hospitalizations for sepsis. Also important to note was that the estimated mean cost per readmission was significantly higher for sepsis ($10,070) compared with pneumonia ($9533) heart attacks ($9424), heart failure ($9051) or COPD ($8417).

So, while recent studies do demonstrate that since the hospital readmission reduction program (HRRP) was launched, readmissions for heart failure, COPD, pneumonia, and heart attack have declined, it would be wise to consider adding sepsis readmissions to HRRP. The potential to avoid hospital acquired infections secondary to readmissions for sepsis would likely help improve health care outcomes.

Its also vital that the public be educated about the dangers of sepsis to facilitate not only early diagnosis and treatment, but rapid dispatch of EMS to the closest emergency department.  While sepsis is a medical emergency in patients presenting to the hospital, the more pressing issue is that persons may develop chronic medical issues that can be lifelong or last for years after treatment and discharge.

Patients who survive an initial hospitalization for sepsis require close follow up and must be monitored for development recurrent or worsening kidney failure as well as recurrent infections, recurrent heart failure as well as ongoing lung problems including multidrug resistant pneumonia, CRE, or even aspiration.

One of the pressing issues that emergency and critical care physicians encounter is the difficulty is identifying patients in the early stages of sepsis.  Some patients may have nonspecific symptoms such as nausea or dizziness, before changes in mental status or vital signs develop.

In addition, our aging population is at greater risk for sepsis, especially patients who have cancer and are receiving chemotherapy, as well as those with chronic kidney disease and  those on hemodialysis.

Data indicates that close to 25% of patients who survive their initial hospitalization for sepsis are then readmitted within 30 days suffering from another potentially deadly infection. But the real challenge is communicating with patients to make them aware of this potential for recurrent infection after initial treatment by instructing them to be aware of early warning signs such as rapid breathing, a low blood pressure, along with confusion or a change in mental status.

In the future, anticipating a recurrent infection may be possible by using wearable sensors to alert clinicians and patients to subtle changes in vital signs (drop in blood pressure, core body temperature, or increase in heart rate) that may be the earliest warning signs of sepsis.

One limitation of this study was that the data was derived from a state-specific registry, so patients could be lost to follow-up, thus underestimating readmission rates.

That said, this study still  provides convincing evidence suggesting that sepsis be added to the current list of medical conditions for the existing CMS-derived hospital readmission reduction program (HRRP).

Read the original article here.