By Dorothy Brooks
Sepsis is responsible for at least 350,000 deaths in the United States annually.1 While many medical facilities have implemented comprehensive efforts aimed at identifying cases early and initiating treatment promptly, findings from CDC suggest there is room for improvement, particularly in smaller hospitals.1
The 2022 National Healthcare Safety Network (NHSN) annual survey revealed that while 73% of participating hospitals reported maintaining a committee that monitors and reviews sepsis care, the percentage dropped to 53% when considering hospitals with 0-25 beds. Further, the survey revealed 55% of all hospitals provided dedicated time for sepsis committee leaders to manage their programs and conduct related daily activities.
Thus, the CDC unveiled a new Hospital Sepsis Program Core Elements initiative, which is designed to guide hospitals toward improvements that are known to improve sepsis care and reduce mortality rates.2 CDC Director Mandy Cohen, MD, MPH, and others involved with developing the initiative shared details about the new program during a presentation on Aug. 24.
“We know that programs dedicated to the care of patients with sepsis have been successful in saving more lives, reducing the amount of time patients need to stay in the hospital, and cutting healthcare costs,” Cohen said. “The bottom line is CDC believes sepsis programs in every hospital — regardless of size, location, and resources — can strengthen the quality of care delivered to these patients and ensure their survival.”
Raymund Dantes, MD, MPH, a CDC medical advisor, assistant professor of medicine at Emory University in Atlanta, and one of the primary developers of the sepsis initiative, explained that the core elements are intended to provide a manager’s guide on how to organize staff and make the appropriate resources available to improve sepsis care and save lives.
“The approach was modeled after CDC’s Core Elements of Antibiotic Stewardship, which have proven to be an impactful resource to protect patients from the harms caused by unnecessary and inappropriate antibiotic use,” he said.3 “The sepsis core elements are created with the expectation that all hospitals and their patients would benefit from this resource.”
Core Element 1: A commitment from health system leadership to dedicate the human, financial, and information technology resources required for their sepsis efforts to be successful, Dantes explained.
Core Element 2: Accountability. “It’s important for sepsis programs to appoint a leader responsible for program outcomes and to set concrete options,” Dantes said.
Core Element 3: Multidisciplinary expertise. “Sepsis care spans the continuum of hospitalization, and requires coordination of many services and disciplines,” Dantes noted. “It is critical to engage those key partners throughout the organization, such as the emergency departments, intensive care units, [governing] boards, physicians and nurses, specialists, and those caring for distinct populations, such as pediatrics or labor and delivery.”
Core Element 4: Action to implement the structures needed to improve the identification and management of sepsis, and to bolster recovery. “These recommendations complement the clinical guidelines for early recognition and early management, and they provide additional guidance for supporting patients recovering from sepsis,” Dantes said.
Core Element 5: Tracking progress regarding sepsis care initiatives and following related data so program leaders better understand outcomes and goals.
Core Element 6: Reporting stresses the importance of providing useful feedback on sepsis treatment to healthcare providers and sharing usable data to all stakeholders.
Core Element 7: Education. Health systems should properly train healthcare providers on the identification and management of sepsis, including a thorough review of evidence-based treatment protocols. This element also stresses the importance of ensuring patients and caregivers understand the complex condition, too.
Chris DeRienzo, MD, the American Hospital Association’s (AHA) senior vice president and chief physician executive, stressed the importance of identifying sepsis early and beginning treatment with appropriate antibiotics. He did note accomplishing these goals is challenging because sepsis is not just one disease.
“In my specialty’s population of sick and extremely premature newborns, the early warning signs of sepsis can look wildly different than those of trauma patients who have surgery or of elderly patients in a nursing home,” he said during the Aug. 24 briefing. “This is why it is crucial to have leadership commitment to supporting the early identification and early treatment programs.”
DeRienzo added hospital sepsis initiatives require energy, resources, and attention to build the kind of standard processes that improve outcomes. “Sepsis is a complex condition, and its early signs can often be masked when patients have multiple issues,” he said. “It is essential to [bring] together experts from across the hospital in a multidisciplinary approach to build programs that are targeted at early identification and treatment.”
When asked why sepsis is so hard to identify, Hallie Prescott, MD, MSc, a pulmonary and critical care medicine specialist, said symptoms of sepsis can overlap with other types of conditions, making it particularly challenging to diagnose. “We wish we had one blood test or one diagnostic test that could say, yes, this patient has sepsis or, no, this patient doesn’t, but we just don’t have that,” said Prescott, who works at the University of Michigan Medical School, a recognized expert on sepsis care and a co-developer of CDC’s sepsis initiative. “It does really require a holistic assessment of the patient’s clinical presentation as well as their presenting testing.”
Some of the better sepsis programs can function similarly to a well-oiled NASCAR pit crew, according to DeRienzo. “We must do everything we can to break down barriers that exist to getting patients identified as early as possible and treated as early as possible,” he said. “The evidence to do so is clear, and it saves lives.”
One aspect of the new CDC program the AHA particularly appreciates is the fact it does not put forward a one-size-fits-all approach. “The core elements allow our hospitals to build a program that fits their communities [and can be] practiced in large centers and in some very small centers,” DeRienzo said.
Prescott said making the program flexible was a key goal. “For some hospitals that are part of a larger healthcare system, some of the work can be done across the entire health system to try to conserve resources,” she said.
Prescott highlighted the fact many hospitals have already invested in sepsis. “We want to make sure that investment is doing the most that it can,” she observed. “Sepsis contributes to 1.7 million hospitalizations annually, and accounts for more than one-third of all U.S. hospital deaths ... We want to make sure that hospitals are doing the best they can with the resources they have to address sepsis.”4
Dantes acknowledged individual hospitals will be initiating sepsis improvement work in different positions, based on their size, available resources, and other factors. Dantes estimated the number of facilities starting from scratch is about 1,400. “They don’t have a sepsis committee yet, and we want to encourage them to go ahead and get started,” Dantes said. “For those hospitals that already have sepsis programs underway and have available resources, we have a lot more details and best practices that we’ve collected from hospitals about how to further improve.”
REFERENCES
1. Dantes RB, Kaur H, Bouwkamp B, et al. Sepsis program activities in acute care hospitals – National Healthcare Safety Network, United States, 2022. MMWR Morb Mortal Wkly Rep 2023;72:907-911.
2. Centers for Disease Control & Prevention. Hospital Sepsis Program Core Elements.
3. Centers for Disease Control & Prevention. Core elements of antibiotic stewardship. Page last reviewed Sept. 7, 2023.
4. Prescott HC, Posa PJ, Dantes RB. The Centers for Disease Control and Prevention’s Hospital Sepsis Program Core Elements. JAMA 2023; Aug 24. doi: 10.1001/jama.2023.16693. [Online ahead of print].
Agency leaders believe sepsis programs in every hospital — regardless of size, location, and resources — can strengthen the quality of care delivered to patients and ensure their survival.
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