Two years ago, New York City’s Mount Sinai Hospital was struggling to catch cases of sepsis early enough to save lives. Since then, the hospital has almost halved the number of sepsis deaths taking place there thanks to use of its EMR, according to a piece in the Canadian Medical Association Journal.
Attacking sepsis deaths is critical for hospitals worldwide, which have been fighting what has been described as a losing battle against the condition. According to the CMAJ, hospitalizations for sepsis have more than doubled over the last 10 years, and an estimated 1/3 to 1/2 of those patients die as a result of the condition.
Early treatment with antibiotics and intravenous fluids can reduce the risk of death from sepsis by half, but treatment is often delayed because symptoms are not specific enough to raise the alarm.
In 2011, Mount Sinai’s overall mortality rate and sepsis mortality rate were both unusually high compared with other academic medical centers in the U.S., according to Dr. Charles Powell, chief of pulmonary and critical care medicine, who spoke to CMAJ. Sepsis, in fact, accounted for about half of all deaths at the hospital.
Mount Sinai implemented an early warning and response program on eight floors, beginning in 2012, in which the hospital’s EMR triggered a red alert whenever staff entered vital signs in a patient’s chart that matched the criteria for early sepsis.
When the alert was triggered, it prompted a bedside call from a team of specially trained nurse practitioners who evaluated the patient, ordered tests, and if necessary began immediate treatment.
During that first year there were 77 fewer deaths from sepsis, representing a 40 percent reduction in the hospital’s sepsis mortality rate compared to 2011. Since then, things have only gotten better.
“When we began the program, the mean sepsis mortality rate was about 33 percent… Now it’s at 16 percent,” close to the lowest rates among peer hospitals, says Powell. Not only that, the hospital identifies patients with sepsis earlier so it can standardize its response. Then, using EMR data, the hospital can also measure it sepsis response in terms of timeliness and outcomes, including both transfers to intensive care and mortality, Powell notes.