Each year, more than one million people in this country develop a serious condition known as sepsis, and for around half of them, it proves fatal. Sepsis begins with the body’s natural response to combating infection (pneumonia and urinary tract infections are among the most common catalysts). But unlike a normal physiological response, sepsis results in systemic inflammation that, if left untreated, can lead to organ shut-down.

According to the San Diego-based advocacy organization Sepsis Alliance, this condition causes more deaths in the nation’s hospitals than any other. The price tag for treating sepsis is around $24 billion per year.

One thing that makes sepsis insidious is how challenging it is to diagnose. Treatments have the best chance of success when begun early, but once septic shock sets in, the prognosis sharply worsens.

CMS sets up anti-sepsis rules…but are they enough?

Two years ago, the Centers for Medicare & Medicaid Services (CMS) instituted new rules for hospitals that address this critical issue. The CMS now requires facilities to monitor sepsis treatment in a systematic way: once a sepsis diagnosis has been made, a specific course of action must be followed, including administering the patient IV fluids and broad-spectrum antibiotics. Further, the CMS stipulates that the critical care steps must be carried out within three hours of diagnosis.

However, is this federally mandated protocol enough to combat the deadly force of sepsis? St. Joseph Hospital in Orange doesn’t think so. They’ve set up a dedicated program for treating and preventing sepsis that goes above what the government requires: their program includes designated nurses and coordinators.

California Healthline recently profiled St. Joseph and some of the individuals trying to do more in the war against sepsis. Dawn Nagel is one of the nurses in the St. Joseph anti-sepsis program. While she’s been a nurse at the hospital for 18 years, Nagel’s goal these days is to intercede in cases of sepsis, thereby improving patient survival rates. Tasked with blood draws, identifying instances of sepsis, and dispensing medication and IV fluids, she is often racing against the clock.

“We are the last line of defense,” Nagel said. “We’re here to save lives. If we are not closely monitoring them, they {patients] might get sicker and go into organ failure before you know it.”

Dedicated health professionals “make a huge impact” in reducing sepsis tragedies

St. Joseph Hospital is part of the larger seven-hospital system of St. Joseph Hoag Health based in Orange County. Hoag Hospital in Irvine and Hoag Hospital in Newport Beach administered the inaugural dedicated sepsis programs in 2010. Since then, four more hospitals in the Hoag family have followed suit.

Tom Ahrens is a research scientist at Barnes-Jewish Hospital in St. Louis; he is also on the advisory board of the national Sepsis Alliance. “From a clinical point of view, from a cost point of view, they [dedicated sepsis nurses and coordinators] make a huge impact,” he told California Healthline.

Dr. Andre Vovan oversees the anti-sepsis programs for the St. Joseph Hoag network. He reports that the health system as a whole encounters approximately 8,000 sepsis cases annually and spends around $130 million treating them. Although St. Joseph Hoag utilizes tech tools like a care-coordinating mobile app and sepsis treatment checklists, Vovan acknowledges that no tool, no matter how savvy, can take the place of the dedicated nurses themselves. “Their familiarity allows them to do it faster.” And with this condition, time is of the essence.

Anti-sepsis nurses also educate families about sepsis treatment and recovery. “We want the families to understand that just because you survive sepsis, it doesn’t mean you can get home and run a marathon,” Vovan said. “It can take weeks to months to recover.”

Early statistics promising

Although it’s barely been two years since implementation across all facilities, the anti-sepsis program at the St. Joseph Hoag Health system is already showing positive results. Vovan reports a three-percent reduction in patient deaths from septic shock from 2015 to 2016, as well as a three-percent reduction in all cases of sepsis. In addition, he says that the average duration of a sepsis-related hospital stay is also decreasing. And more specifically, at St. Joseph Hospital in Orange, the rate of septic shock has been cut in half, this according to Cecille Lamorena, overseer of sepsis nurses at that facility.

Each of the facilities within the St. Joseph Hoag system makes it a point to have a designated sepsis nurse on duty 24/7. But the attendant demands might be surpassing what any one person can meet. Case in point: Dawn Nagel stated that “sometimes I feel there should be three of us.”


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