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Each year, sepsis affects millions of patients in a myriad of hospital settings in the United States, resulting in the death of up to 50% of those afflicted. Many of these deaths are dependent on age, severity of illness, the adequacy and timeliness of therapy, and other factors. Costs associated with sepsis are staggering and estimated to be in the billions. The disease has become a focus of many quality improvement efforts as more hospitals are seeking new strategies to reduce associated mortality rates. The goal of these efforts is to improve processes and the delivery of care so that improved and more cost-effective outcomes can be achieved. In light of the recent development of various therapies—including early, goal-directed therapy and corticosterioids—use of evidence-based protocols is essential to reduce the burden of sepsis in U.S. hospitals, ICUs, and emergency departments.

Use Evidence-Based, Protocol-Guided Care

Clinical care continues to move toward evidence-based protocols that apply interventions from evidence-based studies. A number of interventions for managing sepsis have been researched, but these investigations have never “bundled” several protocol applications concurrently. In the May 2007 issue of Critical Care Medicine, my colleagues and I conducted a retrospective analysis that examined the clinical impact of bundling care using data from the Surviving Sepsis Campaign guidelines and recent literature. The purpose was to deliver effective care during the early and late stages of sepsis. Our bundled care model emphasized several key points:

• Identification of patients with septic shock.

• Aggressive fluid resuscitation.

• Timely and appropriate antibiotic administration.

• Other adjunctive and supportive measures.

Previous studies have shown that these protocols have favorable effects on sepsis survival and organ dysfunction. Our study also looked at the economic impact of the application to determine cost effectiveness.

After collecting data before and after implementation of our sepsis protocol, we found that survival rates increased from 52% to 70% after the protocol was implemented and the average hospital length of stay reduced by 5 days. Median total hospital costs per patient were considerably less after the implementation of the sepsis protocol ($21,985 before the intervention down to $16,103 after) and remained less even when we only considered the survivors. The total cost savings were estimated to be $573,000, despite higher rates of survival after protocol implementation.

Save Lives & Money

A key finding from our study is that establishing system-wide, evidence-based protocols for physicians and institutions caring for patients with severe sepsis appears to help reduce expenditures while saving lives at the same time. The development of these protocols can help physicians generate mental checklists and simplify procedures for a complex disease. Furthermore, there doesn’t need to be a tradeoff of costs and benefits for all institutions; in some cases, we can take pieces already in place and reassemble them into a better system that improves outcomes and decreases costs.

It’s possible to significantly diminish the incidence and magnitude of sepsis in more productive ways by: focusing on earlier, more aggressive fluid resuscitation; emphasizing appropriate administration of antibiotics; and using adjunctive therapies when appropriate. Protocols may be needed to better educate staff on sepsis management so that earlier identification of patients who meet specific criteria can be facilitated. Another important aspect to consider is that hospitals need to take ownership and have an advocate for newly implemented protocols. It may take time and energy, but it’s clearly a worthwhile effort so that these patients can be better managed at each hospital.

Andrew F. Shorr, MD, MPH, has disclosed to Physician’s Weekly that he has worked as a consultant and investigator for AstraZeneca and Eli Lilly.