Results from a sepsis care study for Q1 2018 show that only 1.5 percent of U.S. hospitals provide adequate care for patients diagnosed with sepsis. The study was based on data released by the Centers for Medicare & Medicaid Services (CMS), which measures how Medicare-certified hospitals perform on various quality measures.
CMS reviewed more than 4,000 Medicare-certified hospitals, and assigned scores based on compliance with quality benchmarks. For sepsis care, that benchmark is the SEP-1: Early Management Bundle Severe Sepsis/Septic Shock guideline. This guideline outlines sepsis care in the hospital setting, including testing, treatment, and follow up.
At Brown, Christie & Green, our Houston sepsis lawyer took the CMS data a step further to breakdown the information and provide Texans with information about how local hospitals perform. The information was broken down by county, and averaged to show how Texas hospitals compare to the state average and the national benchmark.
Sepsis Care Study Results for Texas
During the data collection process, 405 Texas hospitals were reviewed, measured, and scored. The sepsis care study showed that the average for SEP-1 compliance in Texas hospitals is 51 percent. Some counties scored better than others, with several falling far below the national benchmark of 53.5. Several fall below both the state and national averages, with scores including:
- Harris County – 42%
- Bexar County – 40.6%
- Dallas County – 61%
- Travis County – 61.4%
- Tarrant – 57%
- El Paso – 54.4%
- Nueces – 44%
- Collin – 67.5%
- Webb 23.5%
What is most disturbing about these results is the fact that sepsis can often be prevented, and if infections are caught quickly, can be successfully treated. Sadly, these scores suggest that hospitals are failing to take measures to prevent or adequately treat cases of sepsis. This places patient lives at risk.
Nationwide Sepsis Care Study Results
In our Nationwide Sepsis Care Study, instead of using just the number scores, we assigned standard grades based on percentages. Using a standard grading system provides a better perspective of the real impact of compliance with the SEP-1 guideline.
As noted by attorney Charles Brown in our Nationwide Study, “People are dying because hospitals are failing”… “If a hospital only gives appropriate treatment 60% of the time, that isn’t 3 stars, that is a failing grade.”
And fail is exactly what the majority of hospitals across the U.S. did in the CMS data. Using the grading system, we see the following:
- Only 1.5% of U.S. hospitals received an A.
- 5% of hospitals received a B.
- 7% of hospitals received a C.
- 7% of hospitals received a D.
- A startling 74.8% of hospitals received a failing grade.
The results of this sepsis care study highlight a serious problem in our hospitals. Healthcare-acquired infections (HAIs) are already a serious concern, but this takes that concern to new heights as sepsis prevention and treatment are clearly lacking.
There are a lot of misconceptions about sepsis. Some believe it is an infection, others believe it is the result of poor hygiene. In reality, sepsis is a medical condition that develops as the body responds to an infection. That means any infection – from something as small as an infected toenail or bug bite, to more serious infections like pneumonia or meningitis.
What’s more, sepsis can develop from infections that are bacterial, viral, fungal, or parasitic. Sepsis develops when the body responds to one of these infections with an overwhelming response With such a wide range of risks, infection control and appropriate care for sepsis are important elements of any healthcare environment.
While sepsis can develop from any infection, in hospitals, sepsis commonly develops in patients who have HAIs. This is because these patients may have a lowered immune system or be vulnerable due to other medical conditions. Sepsis develops more commonly in patients with HAIs caused by:
- Any treatment that causes a break in the skin
- Any procedure that introduces a medical device or equipment into the body
- Central Lines – Central lines are inserted into large veins, and can introduce bacteria into the bloodstream. Central line-associated bloodstream infections (CLABSI) are serious, and can definitely lead to sepsis if not properly treated.
- Urinary Catheters – Urinary catheters are common in patients having surgery, or who will be immobile for extended periods of time. These catheters commonly cause urinary tract infections (UTIs), which are further classified as catheter-associated UTIs, or CAUTIs. Estimates suggest that 75% of UTIs in hospitals are CAUTIs.
- Surgery – Any type of surgical procedure increases the risk of infection, especially around the surgical site. Surgical site infections (SSIs) are one of the more common HAIs, and are also a common cause of sepsis. Surgery involves breaking the skin and exploring or manipulating deeper tissues and organs. This exposes your body to infection on many levels.
- Ventilators – Patients who require assistance with breathing may be placed on a ventilator. A ventilator requires the patient be intubated, with a tube run down their throat to the lungs. Unfortunately, without proper monitoring and care, the tube can act as a route of exposure for bacteria, which can lead to ventilator-associated pneumonia (VAP). Pneumonia is an infection very commonly associated with sepsis.
Patients who are immunocompromised or who suffer from certain medical conditions are particularly vulnerable to infection and sepsis. Patients admitted to the hospital may have multiple risk factors, including medical conditions that put them at a higher risk, such as:
- Patients with no spleen
- Patients receiving chemotherapy
If symptoms of sepsis emerge, hospital staff must respond immediately, following clinical guidelines. Using the SEP-1 guideline, hospitals must respond to sepsis symptoms with a series of tests and interventions. These interventions must take place within three or six hours, depending on the presentation. Following these guidelines and intervening quickly can reduce the risk of complications or death tremendously.
The Human Cost of Sepsis
It is one thing to view the results of our sepsis care study, see a series of numbers, averages, or grades and be taken aback by the results. It is something else entirely when human factors are added to the equation. Consider these facts from the Sepsis Alliance:
- Sepsis is the leading cause of death in hospitals across the U.S.
- Sepsis causes more deaths each year in the U.S. than breast cancer, prostate cancer, and AIDS combined.
- Each year, around 30 million people worldwide develop sepsis.
- Sepsis claims the lives of more than 8 million people each year, including over 3 million children.
- The rate of sepsis in the U.S. is 1.7 million diagnoses each year. That accounts for one diagnosis every 20 seconds.
- Sepsis causes more than 260,000 maternal deaths each year, and is considered a driving force in increasing rates of pregnancy-related deaths.
- Mortality rates for sepsis increase as much as 8% for each hour that passes without treatment being initiated.
- Estimates suggest that 80% of sepsis deaths could be prevented with timely diagnosis and treatment.
What makes these facts and figures even more alarming is the fact that recent studies have shown that mortality rates related to sepsis are increasing. Sepsis has been defined by researchers as a burden with a tremendous cost.
Though research is ongoing and efforts are being made to educate and train healthcare professionals and the community about sepsis, there is still a great deal of room for improvement. The preventable loss of life due to sepsis care in hospitals is unacceptable.