Welcome to the September Issue of
HIIN The Know
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This month,
HIIN The Know
focuses on sepsis.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
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Sepsis is prevalent. Globally, there are potentially 5.3 million sepsis deaths each year.
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Sepsis is expensive. It is one of the costliest in-patient hospital conditions with an: annual hospital cost of $23.6 billion, average cost-per-day hospital stay of $18,400 (which is double other conditions), and annual cost of readmission after sepsis of $4.0 billion.
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Sepsis is a medical emergency. Every hour delay in tailored antibiotics equates to a 7.6 percent increased likelihood of mortality.
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According to Sepsis Alliance, those at-risk for sepsis include the very young, the very old, those with chronic illnesses, and those with weakened immune systems. Providing sepsis care quickly and correctly improves outcomes and makes care simpler. Common treatment challenges include lack of identification preventing early treatment and fluid resuscitation issues.
Sepsis does not stop at discharge. Survivors often suffer from cognitive dysfunction; functional disabilities; and symptoms of depression, anxiety, and/or post traumatic stress disorder (PTSD).
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Sepsis doesn't just affect survivors. Wives of sepsis survivors are four times more likely to experience symptoms of depression, 25 percent of survivors' relatives had anxiety, and 50 percent of survivors' relatives had PTSD six months after intensive care unit discharge.
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Partnering with HSAG HIIN helps increase sepsis awareness, identify best practices, and implement strategies to improve sepsis outcomes.
- Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287
- Fleischmann, Scherag, Adhikari,et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. AJRCCM. Available at: https://www.atsjournals.org/doi/full/10.1164/rccm.201504-0781OC. Accessed on: August 13, 2019.
- Torio C, Moore B. National Inpatient Hospital Costs. HCUP Statistical Brief #204. 2013. Available at: https://europepmc.org/abstract/med/27359025. Accessed on: August 13, 2019.
- Pfunterner et al. Cost for Hospital Stays in the United States, 2011. HCUP Statistical Brief #168. 2013. Available at: https://europepmc.org/abstract/med/24455786. Accessed on: August 13, 2019.
- Hines et al. Conditions with the largest number of adult hospital readmissions by payer, 2011. HCUP Statistical Brief #172. 2014. Available at: https://europepmc.org/abstract/med/24901179. Accessed on: August 13, 2019.
- Kumar et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock*. Critical Care Medicine: June 2006; 34(6): 589–1596. doi: 10.1097/01.CCM.0000217961.75225.E9. Available at: https://journals.lww.com/ccmjournal/Abstract/2006/06000/Duration_of_hypotension_before_initiation_of.1.aspx#print-article-link. Accessed on: August 13, 2019.
- Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis. JAMA. 2010;304(16):1787–1794. doi:10.1001/jama.2010.1553
- Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc. 2012;60(6):1070–1077. doi:10.1111/j.1532–5415.2012.03989.x
- Rosendahl et al. Physical and Mental Health in Patients and Spouses After Intensive Care of Severe Sepsis. Critical Care Medicine. January 2013;41(1): 69–75. doi: 10.1097/CCM.0b013e31826766b0. Available at: https://cdn.journals.lww.com/ccmjournal/Abstract/2013/01000/Physical_and_Mental_Health_in_Patients_and_Spouses.9.aspx. Accessed on: August 13, 2019.
- Davydow et al. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission. Crit Care Med. 2012. pp. 2335–41. Available at: https://www.sciencedirect.com/science/article/pii/S0163834312003933. Accessed on: August 14, 2019.
- Jones et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intens Care Med. March 2004: 30(3): 456–60. Available at: https://link.springer.com/article/10.1007/s00134-003-2149-5. Accessed on: August 14, 2019.
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HSAG HIIN Hospitals' Current Sepsis Progress
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The chart below indicates relative improvement rates for sepsis 30-day mortality, sepsis 30-day readmission, and all-cause 30-day readmission, as well as the percent of 30-day readmissions due to sepsis.
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Improvement Tools and Resources
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Sepsis Field Guide
This field guide contains valuable sepsis-related information including the harm impact of sepsis, the sepsis measure, known improvement strategies, and specific resources.
Click here to view the field guide
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Sepsis Alliance—Sepsis Awareness Month Toolkit
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Seven-Day Readmission Checklist and Audit-Tool Instructions
This one-page checklist and audit tool prompts clinical or quality staff members to review a list of factors commonly attributed to preventable hospital readmissions. The review can help users understand the kinds of barriers patients, families, and providers face during preparation for discharge and post-hospital transitional care.
Click here to view the checklist and audit tool.
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Centers for Disease Control and Prevention—Life After Sepsis Fact Sheet
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The Data Advantage Corner
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Hospital Readmissions and Healthcare-Associated Infection (HAI) Reports
Now Available!
The hospital readmissions report provides a summary of your hospital’s Medicare FFS readmissions data through Q1 2019 and provides overall and stratified readmission rates—allowing your hospital to identify key areas of focus. The HAI report provides an overall summary of HAI measures and an update on your hospital’s National Healthcare Safety Network data from Q2 2018 through Q1 2019.
To find your hospital’s readmission and HAI reports:
- Log in to the HSAG HIIN Secure Data Portal.
- Select the Reports tab.
- Locate your hospital’s report within the Readmission or HAI Reports drop-down menu.
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Upcoming Events and Education
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PFE Think Tank:
Partnering with Patients and Families to Improve Care Transitions
Tuesday, September 17, 2019
12 noon to 1 p.m. PT
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Tell us about a best practice or noteworthy story you would like to share with the HSAG HIIN community. What you do makes a difference, so please share!
“S” is for Stroke, STEMI, and Sepsis: One Organization’s Process to Treating the Septic Patient
This hospital best practice story was used previously in the April 2018 newsletter. Scripps Health knew that it was doing well with stroke and ST-Elevation Myocardial Infarction (STEMI) but identified an opportunity when it came to treating a septic patient.
Click here
to view strategies used by Scripps Health for successful sepsis patient treatment.
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