How to Reduce Sepsis Mortality at Hospitals and Health Systems

December 5, 2024 ‐ HealthLeaders Media

By Christopher Cheney

The Providence health system and a hospital that is part of the Franciscan Missionaries of Our Lady Health System have made strides in reducing sepsis mortality.

Sepsis is the body’s extreme reaction to an infection that can result in tissue damage and organ failure. Annually in the United States, there are at least 1.7 million adult hospitalizations for sepsis and at least 350,000 deaths from the condition, according to the Centers for Disease Control and Prevention.

Providence reduces sepsis deaths three years in a row

A HealthLeaders story published in July details how Providence has decreased sepsis mortality at the health system’s hospitals.

“Sepsis care is a key focus for us,” says Hoda Asmar, MD, MBA, executive vice president and chief clinical officer at Providence. “We have made significant strides, and we will continue to make strides. This is something we are going to be working on for years to come, and we are saving lives.”

Asmar says Providence focused on two sepsis care processes in 2021 and 2022. The health system more than doubled use of a standardized order set for sepsis patients. The primary elements are blood work and tests used to diagnose sepsis, administration of antibiotics, intravenous fluid resuscitation, and management of hypotension. Providence now uses the order set for 76% of patients presenting with sepsis and hopes to raise that rate to 80%.

Additionally, the health system set a goal to have the first antibiotic administered within one hour of identifying a patient with sepsis. It’s currently meeting this goal for 77% of patients, with a target of 80%. Asmar says those efforts helped reduce sepsis deaths from 2021 through 2023.’

Providence’s end goal is to be at a rate better than expected mortality, Asmar explains. The health system measures sepsis mortality using the ratio between observed mortality and expected mortality.

“The expected mortality comes from a benchmark based on the acuity of the patients we see,” Asmar says. “We want to be better than 1.0 on the sepsis mortality ratio of observed mortality and expected mortality.”

In 2021, Providence ended the year with a sepsis mortality observed-to-expected ratio of 1.11. In 2022, that ratio was 1.04, and in 2023 the ratio was 0.90. Last year, the health system saved an estimated 1,250 lives of sepsis patients, according to Asmar.

Asmar says Providence is now focusing on four more areas to improve sepsis care.

First, the health system is looking at gaps between its care performance and the Centers for Medicare & Medicaid Services’ sepsis bundle expectations, which include early antibiotic use, timing of blood cultures, fluid resuscitation, and management of hypotension.

Second, Providence is looking at sepsis care through a health equity lens. Nationally, several patient populations experience worse sepsis outcomes than white patients, including Black patients and Hispanic patients. The health system wants to solve the unique challenges of vulnerable populations and is working on educational tools in languages other than English.

Third, the health system is also focusing on early intervention. The earlier that clinicians can identify sepsis and intervene, the fewer complications and deaths. Providence is focusing on key settings such as emergency departments and urgent care centers. One strategy involves using the EHR to monitor vital signs such as blood pressure, heart rate, and respiratory rate and give clinicians an early warning when sepsis is detected.

Finally, Providence is using the EHR to manage care for patients who are admitted to a hospital for a different diagnosis but show signs of sepsis or septic shock.

Using AI to boost sepsis patient outcomes

Another HealthLeaders story from July featured a Baton Rouge, Louisiana-based hospital that has generated positive results such as reduced cost of care and lower sepsis mortality from using an artificial intelligence-driven early diagnosis tool for sepsis.

Our Lady of the Lake Regional Medical Center has adopted IntelliSep, an AI-driven sepsis diagnostic testing system developed by San Francisco-based Cytovale Inc. IntelliSep gained Food and Drug Administration approval in January 2023.

IntelliSep determines the presence or absence of sepsis by measuring the activation of a patient’s immune system, says Catherine O’Neal, MD, former CMO at Our Lady of the Lake Regional Medical Center and chief academic officer at Franciscan Missionaries of Our Lady Health System.

“As a patient approaches severe sepsis and septic shock, the immune system is more activated,” O’Neal says. “IntelliSep measures the range of activation from a patient who is not activated at all to a patient who has a highly activated immune system against an infection. Highly activated patients tend to be more likely to have septic shock.”

IntelliSep is one of several AI-driven sepsis diagnostic tools that have been developed in recent years. Other AI-driven sepsis diagnostic tools include the following:

Steripath, which decreases blood culture contamination to increase sepsis testing accuracy
Sepsis Immunoscore, which is an AI and machine learning software that is designed for rapid diagnosis and prediction of sepsis
Targeted Real-Time Early Warning System, which is an algorithm developed at Johns Hopkins Medicine that is integrated into electronic health records and is designed for early recognition of sepsis

A study published in Academic Emergency Medicine found that IntelliSep correctly identified which patients did not have sepsis 98% of the time, making it an essential tool for clinicians to rule out sepsis and explore alternative diagnoses.

IntelliSep has decreased the number of blood cultures taken at the hospital, which has reduced cost of care, says Christopher Thomas, MD, vice president and chief quality officer at Franciscan Missionaries of Our Lady Health System.

Data shows that IntelliSep has had a positive impact on patients and operations at Our Lady of the Lake Regional Medical Center, Thomas says.

The hospital conducted 1,800 less blood cultures in six months than the facility did in a six-month span a year ago
Length of stay for sepsis patients in the ICU has been reduced by two days
Since adopting IntelliSep, the hospital has reduced sepsis mortality by 20%

Christopher Cheney is the CMO editor at HealthLeaders.

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