It may come as a surprise that sepsis is the most common medical reason for admission to Mount Nittany Medical Center. It is the 11th leading cause of death in America, affecting more than one million Americans annually; yet, most people have never heard of it.
Sepsis is a potentially life-threatening complication of an infection that can originate in any part of the body, such as the lungs (with pneumonia), abdomen, urinary tract or skin. When patients come to the hospital with sepsis, the infection has caused inflammation throughout the body when their immune system tried to fight the infection. Typically, the body’s immune system can treat the infection without serious problems; however, with sepsis, the immune system goes into overdrive. The chemicals released into the bloodstream to fight the infection cause the inflammation in the body. This response is called systemic inflammatory response syndrome, and the inflammation can trigger a number of changes that damage multiple organs, such as the kidneys.
Sepsis is viewed as a three-stage condition, starting with mild sepsis and progressing through severe sepsis to septic shock. Most people recover from mild sepsis, but the mortality rate for septic shock is close to 50 percent.
The risk of death increases by almost 7.6 percent with every hour that passes without treatment — making time of the essence in diagnosing and treating patients with sepsis. Early intervention for sepsis, usually with broad-spectrum antibiotics and large amounts of intravenous fluids, improves chances of survival. ICU care, along with medications to prevent shock and other interventions to support organ function, may also be necessary.
A big challenge in treating sepsis is the fact that diagnosing it is sometimes difficult — especially in the early stages, when its signs and symptoms can be easily missed or attributed to more common causes. Fever and minor changes in heart rate or respiratory rate are among the associated symptoms. These signs could simply be associated with pain or anxiety, which are common conditions already experienced by most patients coming to the emergency department for care.
In spite of outcomes that are already very favorable for patients treated for sepsis at Mount Nittany Medical Center, a multidisciplinary team worked has been working together throughout the year to take sepsis care to the next level. The team’s participation in the Highmark Health Services’ Hospital Quality Blue Pay for Performance Program brought several positive results, including the development of a process to better diagnose and treat patients with sepsis.
The team developed an electronic process to help identify the subtle changes that may indicate sepsis. Through this process, a patient’s file is “flagged” when it shows two or more signs of sepsis, prompting prioritized assessment by a provider. Special laboratory testing was made available right in the emergency department, allowing point-of-care personnel to get important information into the hands of providers, which facilitates faster treatment. Evidence-based order sets were developed to help provide efficient and appropriate treatment earlier. Lastly, provider education and regular performance feedback helped finalize the process. To date, Mount Nittany Medical Center has seen encouraging outcomes from this process.
If you or a loved one has signs of an infection, such as an inflamed wound or blood in the urine, it is vital to receive immediate medical care as the infection could lead to sepsis if left untreated.
Marlene Stetson is the infection prevention and control coordinator at Mount Nittany Medical Center.