By Using Designated Treatment Guidelines, Two Hospitals Have Reduced Septic Shock Deaths by 80% Compared to Some National Averages
Salt Lake City, UT (6/5/2010) – By using strict treatment guidelines to combat one of the most serious infections that can strike patients, two Utah hospitals – Intermountain Medical Center in Murray and LDS Hospital in Salt Lake City – have dramatically reduced the number of associated deaths from sepsis and septic shock – up to 80 percent over some hospitals – to a level that that is now setting a new national standard, according to the results of a new study.
According to researchers, Intermountain Medical Center and LDS Hospital have reduced the number of sepsis-related deaths to 10.3 percent of patients — a decline of nearly 80 percent compared to some national averages. The dramatic drop comes three years after Intermountain Healthcare made a goal of treating more sepsis patients with a recommended "bundle" of strategies, which mean patients with sepsis are being aggressively identified and treated at a much earlier stage than at most hospitals.
Todd Allen, MD, lead researcher and an emergency medicine physician at Intermountain Medical Center and LDS Hospital, presented findings from the study on June 5 at the Society for Academic Emergency Medicine's annual conference in Phoenix. The abstract findings will also be published in the June edition of the journal Academic Emergency Medicine.
Sepsis is a severe illness in which the bloodstream is overwhelmed by bacteria from an infection. Nearly 500,000 patients arrive in U.S. emergency departments each year with sepsis, which begins as an ordinary infection, such as pneumonia or a urinary tract infection. If the infection progresses, bacteria can enter the bloodstream.
"At that point, the infection affects the whole person, the whole body. Systems begin to shut down and organs fail," says Dr. Allen. "Once that happens, the risk of death may be up to 50 percent or higher. Physicians have always struggled with sepsis, and once someone gets to the septic shock stage, mortality rates are alarmingly high. But we've been able to reduce sepsis-related deaths to a remarkably low level.”
Intermountain Medical Center and LDS Hospital reduced the number of sepsis-related deaths by strictly following a recommended "bundle" of strategies. These include 11 elements that provide consistency in the early recognition and treatment of sepsis, including specialized blood testing, administration of antibiotics, fluids, and other medications, tight glucose control and protecting the lungs with a standardized ventilator strategy.
The bundle was conceived in 2001 as part of a landmark study by another institution. In the years since then, hospital compliance across the country has been spotty, says Dr. Allen.
"Intermountain is among the very first health systems to show huge improvements in a large hospital setting. We may lead the world in overall bundle compliance and survival rate,” he says.
Dr. Allen and other researchers with Intermountain Healthcare based their findings on three years of data from Intermountain Medical Center and LDS Hospital. They looked at patients who arrived at one of the two hospitals' emergency rooms with severe sepsis or septic shock, and who were also over age 18 and not pregnant. The hospitals complied with all 11 elements of the bundle for 22 percent of those patients in 2004-05, 31 percent in 2005-06, and 48 percent in 2008-09. During the same periods, deaths dropped to 18 percent, 17.8 percent and 10.3 percent, respectively.
“The really amazing thing was that in order to get credit for bundle compliance, we had to get all 11 elements right. Even if we missed only one element of the bundle, that counted as a total miss for the purposes of our treatment goal and our study,” said Dr. Allen. “Our clinical teams did some really impressive and important work here.”
Ten of Intermountain Healthcare's hospitals — those capable of providing the acute care sepsis patients require — have committed to using the sepsis bundle to reduce deaths, and the most recent data show that 71 percent of sepsis patients were treated with every element of the bundle protocol. Intermountain's goal is to improve compliance to 77 percent of all cases or more.
Before the discovery of penicillin, sepsis was the No. 1 cause of death in the world. Today, it's still the second leading cause of death among patients in the non-coronary intensive care unit and the tenth leading cause of death in the United States.
"If other hospitals follow Intermountain's example, we may see that statistic fall even more," says Dr. Allen.