Improving Sepsis Education, Identification, and Awareness

By Matt Phillion

Just over a year ago, the Centers for Disease Control and Prevention (CDC) released the Hospital Sepsis Program Core Elements, offering a framework for hospitals to improve sepsis outcomes. These Sepsis Core Elements aid in quickly recognizing sepsis, facilitate implementing evidence-based management of sepsis, and support patient recovery after sepsis.

The CDC also included several questions in the National Healthcare Safety Network (NHSN) 2023 Annual Survey seeking to understand the current state of sepsis programs in healthcare organizations. These questions will help the CDC understand the impact the Sepsis Core Elements are having on U.S. hospitals and where they should focus their efforts going forward to help drive better sepsis care.

The answers received from the NHSN Annual Survey provide some interesting insights into the state of sepsis care in the U.S. Of note: sepsis programs, as well as resources to support them, have increased modestly over the past year. Seventy-eight percent of hospitals reported having sepsis committees in 2023, up from 73% in 2022, while providing dedicated time for sepsis program leaders has improved from 55% to 59%. Sixty-six percent of hospitals reported their sepsis committees involve antibiotic stewardship programs, an improvement from 55% in 2022.

“This was an initial set of questions that provided a baseline for where sepsis committees are in the U.S.,” says Raymund Dantes, MD, MPH, medical advisor for the National Healthcare Safety Network with the CDC and an associate professor at the Emory University School of Medicine.

The improvement in dedicated support for sepsis leaders is a bright spot in the survey numbers, Dantes points out.

“We saw support, which is basically dedicated time and usually salaried time, for sepsis leaders is now at over half of hospitals,” says Dantes. “We see that as an opportunity to improve. A lot of hospitals are getting by with volunteer efforts from staff.”

There’s also an opportunity to grow antibiotic stewardship programs, Dantes notes.

“It’s an important role to help curb unnecessary antibiotic use after a diagnosis and reduce the chance of developing resistance down the road,” he says. “These programs also improve those initial antibiotic choices and ensure they are delivered rapidly.”

Advancements and improvements

The survey questions were sent out in January 2024, not long after the Core Elements were released (August 2023), so the impact of those elements is somewhat difficult to judge just yet.

“For this initial year we have to take those numbers with a grain of salt. They’re answering how they did as a whole, both before and after the Core Elements,” says Dantes. “But we did see areas of improvement we’re happy to highlight.”

For example, 300 additional hospitals now have a sepsis committee compared to the previous year, and 217 additional hospitals now provide sufficient, dedicated time for leaders to focus on sepsis care.

The biggest jump was 629 more hospitals with antibiotic stewardship programs than in previous years, Dantes notes.

“The Core Elements are a summary of best practices from hospitals with high functioning sepsis programs, so it’s just taking those best ideas and putting them in one place,” says Dantes. “I’m the physician lead for sepsis care at my organization and it’s hard for me to know that there’s hospitals out there doing one thing, and others doing something else. We wanted to bring all those best practices into one place, one resource to improve sepsis care.”

The survey results yielded few surprises, but did offer several opportunities where sepsis programs can be strengthened, Dantes says.

“Many programs use different kinds of sepsis tools,” says Dantes. “Seventy-six percent use an EHR-based screening criteria for sepsis upon presentation of the patient, such as when they come into the ER. Seventy-one percent use more than one approach for identifying sepsis. And 86% use an order set to help manage sepsis—a standard set of orders for patients with sepsis, with standardized diagnostic and treatment plans. However, the part we want to highlight is that only 45% track the usability of these tools.”

It’s very important, Dantes says, as there is a tendency for increasing complex EHRs and easy creation of alerts, to create alert fatigue or run into alerts that are easily ignored.

“If you don’t gather feedback from the people using these tools, you could have an order set nobody even uses,” he says. “It’s important to track the usability of these tools so they can be further refined to optimize sepsis care and minimize distractions from other life-saving care.”

It’s an area with a lot of innovation occurring, Dantes explains, and the Core Elements don’t recommend any one particular approach to identify, screen, or predict the onset of sepsis.

“There are so many types of populations out there and a lot of types of hospitals, so there’s no one standard approach,” he says.

Depending on the population, a manual approach screening every patient who comes through tirage may be needed, where others incorporate new predictive models mining data from their EHR to predict the onset of sepsis.

“The field hasn’t settled on one approach, and given the challenge, we think it’s time to study and get feedback on those tools and how they’re performing to help staff deliver the best care possible,” says Dantes. “There’s a lot of great innovation in this space, but not every new tool or idea is going to work in every setting. You have to understand what’s going to help your patient. Evaluating new approaches takes a lot of analytical, methodical work so we don’t create unnecessary noise. If the tool distracts from the care to the patients, then you build distrust in those tools, and you definitely want to avoid that.”

The team is particularly encouraged by the increase in hospitals with leadership support for sepsis programs and antibiotic stewardship.

“We know once you get leadership support, it’s easier for everything else to follow,” says Dantes. “When you have that leadership support, the folks in charge of the program are more likely to receive resources, IT support, the protected salary time to organize and educate staff, all the things that lead to improvements.”

Other areas of improvement

The survey results surfaced some interesting areas to look at for future improvements, Dantes points out. Specifically, there are opportunities for growth in sepsis recovery and discharge planning.

“There wasn’t much emphasis about standardizing patient handoffs, screening for functional or cognitive impairment, staff training at discharge, and post-discharge contacts were only employed by a very few as a standard of practice,” says Dantes. “We’d like to see more improvement in that respect.”

Sepsis education is another area where there is potential to grow.

“Seventy-six percent of hospitals provide education to nurses about sepsis during hiring, but relatively few provide similar education to patient care technicians or certified nursing assistants (CNA), only 22 to 23%,” says Dantes. “These folks often have a lot of face time with the patients. They’re often the ones taking vitals and performing other direct patient care tasks so increasing awareness in these workers could potentially improve early recognition of sepsis among patients.”

The CDC wants to promote more education for these professionals so they can be even more aware of signs and symptoms of sepsis and can notify the right contacts if they suspect a new infection is occurring.

“They are often the first eyes and ears on the patient when their condition changes,” says Dantes.

The Core Elements are meant as a comprehensive guide to help staff make sense of all that needs to be done with treating sepsis in individual organizations.

“In a smaller hospital, you’ll want more effort honing early recognition, stabilization, and transportation of patients with sepsis,” says Dantes. “On the other end of the spectrum, you have organizations with more resources, so there’s opportunity achieve more within the Core Elements such as supporting sepsis survivors if you have the basics down.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.