Sepsis is a severe medical condition in which the body’s response to infection spirals out of control, frequently leading to organ failure and death. It imposes an annual financial burden of $38 billion on the healthcare system and is present in one-third of hospital deaths.
A cornerstone of effective sepsis management is the timely and appropriate use of antibiotics. However, the rise of antimicrobial resistance (AMR), driven partly by the overuse of antibiotics, is making sepsis increasingly difficult to treat.
This places physicians in a difficult situation. On one hand, the urgency of sepsis demands rapid administration of antibiotics. On the other hand, there's a pressing need for physicians to prevent the exacerbation of AMR through responsible antibiotic use.
Antibiotics are becoming increasingly ineffective as drug resistance spreads. Annually, more than 2.8 million antibiotic-resistant infections in the U.S. result in over 35,000 deaths. Coincidentally, the misuse and overuse of antimicrobials are primary drivers in AMR. The Centers for Disease Control and Prevention estimate that up to 50 percent of all antibiotics prescribed in in-patient settings are unnecessary or inappropriate.
To address this urgent health issue, most hospitals have established Antimicrobial Stewardship Programs (ASPs) to promote the responsible use of antibiotics. These programs are co-led by an infectious disease expert and a pharmacist and provide guidelines for improving patient outcomes, reducing microbial resistance, and decreasing the spread of infections caused by drug-resistant organisms.
Many health systems already have interdisciplinary sepsis improvement teams. Allina Health, for example, formed a team of physicians, nurses, quality specialists, and data analysts to improve their sepsis mortality and morbidity rates and lower costs. The team utilized the Health Catalyst® data platform and a robust suite of analytic applications to identify areas for improvement and establish provider trust in the data, thereby achieving a 30 percent decrease in sepsis mortality and $1.1 million in annual cost savings.
Closer collaboration between sepsis improvement teams and ASP teams could identify areas in which guidelines recommending the use of antibiotics and guidelines preventing the misuse of antibiotics conflict with each other. They could then utilize the data platform to alert physicians of a possible conflict and track care variance and outcomes. Armed with this data, sepsis improvement teams could streamline processes to further improve patient outcomes and curtail costs.
Health systems actively employ the Health Catalyst data platform and sepsis analytic applications to combat sepsis. Novant Health New Hanover Regional Medical Center (New Hanover), for example, launched a data-driven sepsis improvement initiative using the Sepsis Analytics Accelerator (SAA). By integrating real-time data, such as vital signs and electronic health record information, into at-a-glance sepsis data displays, they successfully identified and reduced unwanted care variance while improving sepsis mortality rates. This proactive approach led to a remarkable 49.1 percent reduction in sepsis and septic shock mortality rates, resulting in cost savings of $1.5 million and a significant 28.9 percent increase in patients discharged to their homes.
To further optimize outcomes, sepsis-specific applications can be adapted to include guidelines and data related to antibiotic resistance. Integrating clinical guidelines for sepsis bundles and AMR can eliminate confusion, streamline care processes, and reduce treatment delays and variances. The SAA provides critical data and visualizations to enhance sepsis treatment and promptly alerts healthcare providers when their practices deviate from best-practice guidelines. For instance, if there's a deviation from the recommended 3-hour bundle, clinicians receive immediate alerts. This strategic alignment of sepsis care and AMR stewardship has the potential to minimize care variance and facilitate consistent, effective treatment strategies.
Moreover, integrating the SAA with real-time alerts regarding potential antibiotic resistance can significantly support physicians in actively prescribing antibiotics responsibly and effectively. These alerts can offer immediate feedback and actively suggest alternative prescriptions when facing resistance threats. This proactive approach enhances patient care and actively contributes to minimizing the overuse of antibiotics, addressing one of the key drivers of antimicrobial resistance.
Another page from the sepsis playbook is leveraging data transparency to create a culture of excellence. To that end, Thibodaux Regional Health System tasked its sepsis improvement team with promoting an open and transparent flow of information, fostering a culture of accountability among medical practitioners. This heightened sense of responsibility has, in turn, bolstered practitioner performance, resulting in a sustained 36.4 percent relative reduction in sepsis mortality rates over the past three years.
Ensuring that data on antibiotic use and resistance patterns is widely accessible also empowers healthcare professionals to make more informed decisions. This accessibility can potentially help curtail the spread of resistant strains, optimize antibiotic use, and ensure effective patient treatment. By actively embracing data transparency, healthcare systems can catalyze positive changes, not only in sepsis management but also in the critical fight against AMR, ultimately enhancing patient care and safety.
While the challenges of sepsis and AMR are significant, a collaborative data-driven effort presents an optimistic path forward. Indeed, health systems that proactively integrate sepsis and AMR efforts will be better positioned to safeguard patient health and improve outcomes in the face of these global health threats.
