In the Midwest, severe sepsis has approximately a 50% mortality rate among the more than 750,000 cases reported annually in the U.S. As participants in the Kansas Sepsis Project, led by Steven Simpson, MD with The University of Kansas Medical Center, North Kansas City Hospital recently implemented a Surviving Sepsis program. The program aims to help sepsis patients recover and progress to full function faster, which leads to shorter hospital stays. The goal is to reduce mortality and improve outcomes from sepsis by 10% by 2015.
Beating the Clock
“Timely and accurate diagnosis remains a challenge,” says Dr. Simpson. “Seventeen percent of physicians agreed on a definition of sepsis, but 83% thought the diagnosis was often missed.” To help clinicians detect early warning sign of sepsis, updated order sets in the EMR actively evaluate patients’ conditions in real-time. Positive results trigger a sepsis alert. Click here to see Dr. Simpson’s PPT.
Critical care pulmonologist Andrea Anthony MD with Meritas Health Pulmonary Medicine was instrumental in the development of the NKCH sepsis program. “Early and appropriate intervention saves lives. Sepsis can be cured. Awareness and observation are key to identifying early signs of sepsis and NKCH’s new EMR alerts provide a safety net for the clinical staff and patients,” she says.
Successful Treatment Regimen
To be the most successful, treatment regimen should include:
Within 3 hours:
- Measure serum lactate level
- Obtain blood cultures prior to administration of antibiotics (1C)
- Administer broad spectrum antibiotics (1B, 1C)
- Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L (1C)
Within 6 hours:
- Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥65 mm Hg
- In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥4 mmol/L (36 mg/dL)
- Measure central venous pressure (CVP)*
- Measure central venous oxygen saturation (ScvO2)*
- Re-measure lactate if initial lactate was elevated*
(*Targets are: CVP 8 mm Hg, ScvO2 >70%, lactate normal)
The sepsis quality improvement project is funded by Blue Cross and Blue Shield and participating hospitals include the University of Kansas Hospital, Liberty Hospital, Overland Park Regional Medical Center and others. Hospitals share best practices and data and evidence based guidelines and protocols. The North Kansas City Hospital sepsis initiative implemented new evidence based guidelines, order sets and alerts April 1, 2014. The Sepsis project team is led by ICU and rapid response team members and includes hospitalists, pulmonologists, infectious disease, ED, clinical pharmacists, quality and case management.