Nationwide Sepsis Care Study

Study Reveals Startling Number of U.S. Hospitals Fail to Provide Appropriate Care for Sepsis

At Brown, Christie & Green, we want our readers to be informed about trends in healthcare. We have recently reviewed the results of a nationwide sepsis care study, and found a concerning number of U.S. hospitals do not provide adequate or appropriate care for sepsis.

Each year, the Centers for Medicare & Medicaid Services (CMS) conducts a nationwide study examining various measures across more than 4,000-Medicare certified hospitals. The data is collected and reviewed, and hospitals are scored. The data is then moved to a Hospital Compare dataset, which allows viewers to see the scores and how their local hospital compares to others across the country.

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What is Sepsis?

Sepsis is commonly referred to as an infection, a complication, or a blood infection. Terms like septicemia and septic shock are also commonly confused with sepsis, which is a specific medical condition on its own.

Sepsis is medically defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. In simpler terms, sepsis occurs when your body tries to fight off infection, but rather than healing your body, the response is overactive and toxic. The immune system generally fights infections, but the overactive and toxic response causes it to stop fighting and instead, turn on the body.

Sepsis is a response to an infection already present in the body. Any type of infection can lead to sepsis if it is not properly treated. That includes bacterial, viral, fungal, or parasitic infections. In hospitals, the infections that most commonly develop and escalate into sepsis include:

  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Clostridium difficile (C.diff)
  • Vancomycin-resistant Enterococcus
  • Norovirus

When sepsis develops, any of these infections can escalate, and can lead to organ failure, tissue damage, or even death.

In hospitals, sepsis is a tremendous concern because patients with illnesses or injuries are more susceptible to infection. In hospitals, patients are exposed to concentrated germs, which may be introduced directly into the body via central lines, intravenous catheters, urinary catheters, ventilators, or surgical equipment.

Hospital patients can also be exposed to germs by improper sanitation or hygiene on the part of healthcare staff, other patients, or even family members. Patients with chronic illnesses or who are immunocompromised are much more likely to develop hospital-acquired infections and sepsis. This is why the sepsis care study is so important to preserving patient health.

What are the Symptoms of Sepsis?

Patients who are at risk for sepsis should be carefully monitored for any signs of sepsis or other complications. When sepsis first develops, the patient may experience:

  • Fever
  • Difficulty breathing
  • Low blood pressure (hypotension)
  • Increased heart rate

As sepsis escalates, other symptoms will present, and may require urgent medical attention. These symptoms include:

  • Dizziness or fainting
  • Changes in mental state, such as confusion, lack of alertness, or irrational fear
  • Severe muscular pain
  • Slurred speech
  • Skin that is cold and pale
  • Nausea and vomiting
  • Loss of consciousness

During the early stages of sepsis, it can be difficult to make a diagnosis based solely on physical symptoms. Fever, difficulty breathing, and an increased heart rate could indicate a number of medical conditions. It is important to notify healthcare providers or emergency responders of the patient’s recent medical history, including infections.

What is the Proper Treatment for Sepsis?

Sepsis is a medical condition that requires immediate treatment in order to reduce the likelihood of serious complications or death. Basic guidelines indicate that treatment for sepsis includes:

  • Medications: Antibiotics should be administered immediately. Vasopressors are often used to restrict blood flow and increase blood pressure.
  • Intravenous Fluids: Fluids should be started within three hours of detecting sepsis.
  • Supportive Care: Supportive care may include oxygen, ventilator support, or dialysis if kidney function is impaired.
  • Surgery: In some cases, surgery may be required to remove infected tissue, drain abscesses, or remove gangrene. In severe cases, sepsis may escalate to the point of requiring amputation in order to remove the infection.

According to federal guidelines, proper treatment for sepsis includes a series of detailed and specific processes that must be completed within a certain timeframe. This is detailed in the SEP-1: Early Management Bundle, Severe Sepsis/Septic Shock guideline. This is the guideline measured in the nationwide sepsis care study.

According to the SEP-1 guideline, treatment of severe sepsis should include the following:

Within three (3) hours of presentation:

  • Initial lactate level measurement should be taken
  • Blood cultures should be drawn
  • Broad spectrum, or other antibiotics as appropriate, administered
  • If septic shock is present, resuscitate with 30 ml/kg crystalloid fluids

Within six (6) hours of presentation:

  • Repeat lactate level measurement if original level was elevated
  • If hypotension is still present after fluid administration, vasopressors should be administered

Within six (6) hours of presentation of septic shock:

  • Repeat tissue perfusion assessment and volume status that consists of:
    • A focused exam that includes:
      • Vital signs
      • Cardiopulmonary exam
      • Peripheral pulse evaluation
      • Capillary refill evaluation
      • Skin examination
    • Or, any two (2) of the following:
      • Central venous oxygen measurement
      • Central venous pressure measurement
      • Bedside cardiovascular ultrasound
      • Passive fluid or leg raise challenge.

Early detection and treatment using approved guidelines is crucial to preserving patient health and reducing mortality rates.

What Does the Government Study Cover?

In the nationwide sepsis care study, CMS measures various aspects of the clinical process. The goal is to assess hospital performance and increase compliance with federal guidelines. Following proper guidelines has been shown to reduce organ failure, reduce hospital mortality rates, reduce length-of-stay, and reduce overall healthcare costs.

First, patients with a diagnosis of sepsis or septic shock are identified. Next, quality measures are assessed to determine whether or not the patient is receiving care for sepsis that is within the SEP-1 guideline. The government study specifically looks to see if hospital staff are following guidelines, which are laid out very clearly.

These guidelines require healthcare providers to adhere to the three- and six-hour requirements for specific tests and treatment, which were noted above. The sepsis care study checks for compliance by measuring the following:

SepsisSeptic Shock
The measures used to obtain the data include:
• Administrative Contraindication to Care
• Transfer from Another Hospital
• Severe Sepsis Present
• Severe Sepsis Presentation Date and Time
• Directive for Comfort Care, Severe Sepsis
• Discharge Disposition
• Discharge Time
• Calculation of Sepsis Expired Time
• Check Sepsis Expired Time
• Initialize Three- and Six-hour Counters
• Check Initial Lactate Level Collection, Date, and Time
• Check Initial Broad Spectrum or other Antibiotic Administration
• Check Broad Spectrum Antibiotic Administration Date and Time
• Check Broad Spectrum Antibiotic Time
• Check Antibiotic Selection
• Check Blood Culture Collection, Date, and Time
• Calculate Blood Culture Antibiotic Time
• Check Initial Lactate Level Result
• Check Repeat Lactate Level Collection, Date, and Time
The measures used to obtain the data include:
• Check Septic Shock Present
• Check Septic Shock Presentation Date and Time
• Calculate and Check Shock Presentation Time
• Check Directive for Comfort Care, Septic Shock
• Check Discharge Disposition
• Calculate Shock Expired Time
• Check Shock Expired Time
• Check Crystalloid Fluid Administration
• Check Crystalloid Fluid Administration Date and Time
• Calculate and Check Crystalloid Administration Time
• Check Persistent Hypotension
• Check Initial Lactate Level Result
• Check Vasopressor Administration, Date, and Time
• Calculate Vasopressor Time
• Check Vital Signs Review Performed, Date, and Time
• Check Vital Signs Fluid Time
• Check Cardiopulmonary Evaluation Performed, Date, and Time
• Calculate and Check Cardiopulmonary Evaluation Time
• Calculate and Check Cardiopulmonary Fluid Time
• Check Capillary Refill Exam Performed, Date, and Time
• Calculate and Check Capillary Refill Time
• Calculate and Check Capillary Refill Fluid Time
• Check Peripheral Pulse Evaluation Performed, Date, and Time
• Calculate and Check Peripheral Pulse Evaluation Time
• Calculate and Check Peripheral Pulse Fluid Time
• Check Skin Exam Performed, Date, and Time
• Calculate and Check Skin Exam Time
• Check Central Venous Pressure Measurement, Date, and Time
• Calculate and Check Central Venous Pressure Time
• Calculate and Check Central Venous Pressure Fluid Time
• Check Central Venous Oxygen Management, Date, and Time
• Calculate and Check Central Venous Oxygen Measurement
• Calculate and Check Central Venous Oxygen Fluid Time
• Check Shock Physical Assessment Six Hour Counter
• Check Bedside Cardiovascular Ultrasound Performed, Date, and Time
• Calculate and Check Bedside Cardiovascular Ultrasound Time
• Calculate and Check Bedside Ultrasound Fluid Time
• Check Shock Physical Assessment Six Hour Counter
• Check Passive Leg Raise Performed, Date, and Time
• Calculate and Check Leg Raise Time
• Calculate and Check Leg Raise Fluid Time
• Check Shock Physical Assessment Six Hour Counter
• Check Fluid Challenge Performed, Date, and Time
• Calculate and Check Fluid Shock Time
• Check Shock Physical Assessment Six Hour Counter
• Check Sepsis Three Hour Counter
• Check Initial Lactate Level Result
• Check Sepsis Six Hour Counter
• Check Septic Shock Present
• Check Shock Three Hour Counter
• Check Persistent Hypotension
• Check Initial Lactate Level Result
• Check Shock Vasopressor Six Hour Counter
• Check Shock Six Hour Counter

Once the data has been collected, it is evaluated and then hospitals are given a score based on the percentage of patients studied who were receiving appropriate care for sepsis. This score can be compared to other hospitals, and the national benchmark.

Hospitals with a low score indicates a low level of compliance with the SEP-1 standard. For example, a hospital with a score of 5 indicates that only 5 percent of patients were receiving appropriate care for sepsis. Therefore, a hospital with 500 patients included in the sample, scoring only 13 highlights serious deficiencies that put patient lives at risk.

Nationwide Sepsis Care Statistics

With a positive correlation between SEP-1 compliance and reduced mortality rates, it is incredibly important that hospitals strive to obtain a positive score. Hospitals with a compliance rate of 52 percent or higher have proven to reduce mortality rates by as much as 20 percent. Hospitals that score 30 percent or lower have only proven to reduce mortality rates by 4-6 percent. What this proves is that compliance with the SEP-1 standard should be a non-negotiable for preserving patient safety and health.

“People are dying because hospitals are failing.” said Charles Brown, managing partner of Brown, Christie, and Green, a medical malpractice law firm.  “With the efforts made by academia, the government, and advocacy groups, the handling of sepsis patients should not be a mystery, and yet too often patients die from inadequate care.  While CMS gives a star rating, we believe that using traditional school grades more accurately communicates the results.  If a hospital only gives appropriate treatment 60% of the time, that isn’t 3 stars, that is a failing grade.”

Based on the sepsis care study released on February 28, 2019, nationwide sepsis care statistics indicate the following:

  • 1.5 percent of hospitals received an A
  • 74.8 percent of hospitals received a failing grade

For 2018, the national benchmark was 53.5. Hospital grades across the nation reflect the following:

  • The majority of U.S. hospitals fell below the national benchmark:
    • 5% received an A.
    • 5% received a B.
    • 7% received a C.
    • 7% received a D.
    • 8% received a failing grade.
  • The worst-rated hospital for sepsis care was Alliance Health Seminole, in Seminole, Oklahoma, which received a score of 0.
  • The states with the overall lowest scores are the District of Columbia (scored 31), Arkansas (scored 42), and North Dakota (scored 42).
  • The states with the overall highest scores are Hawaii (scored 66), Florida (scored 60), and New Jersey (scored 58).

Sepsis: A Global Health Concern

Sepsis is a serious health risk in hospitals across the U.S., but also in hospitals across the world. The World Health Organization (WHO) estimates that over 30 million people are diagnosed with sepsis each year. Of those, sepsis is suspected of contributing to six million deaths. One of the leading causes of sepsis is hospital-acquired infections, which are estimated to cause hundreds of millions of illnesses each year globally.

Each year in the United States, around one million hospital patients develop sepsis. An estimated 15-30 percent of those patients die from the infection or complications. Increasing rates of sepsis diagnoses combined with high mortality rates have U.S. lawmakers, regulators, and patient advocates searching for ways to improve safety and quality in hospitals.

For more information about the sepsis care study, infection control in hospitals, or your legal rights, contact Brown, Christie & Green.