How Providence Reduced Sepsis Deaths 3 Years in a Row

CCO Hoda Asmar says the health system improved sepsis care during the first two years by focusing on two processes, including early administration of antibiotics.

After committing to improve sepsis care in 2021, Providence has significantly reduced deaths over the past three years.

Sepsis is an extreme response to infection, and it can lead to tissue damage, organ failure, and death. At least 1.7 million Americans develop sepsis annually, and one third of patients who die in U.S. hospitals have sepsis during their hospitalization, according to the Centers for Disease Control and Prevention.

"Sepsis care is a key focus for us," says Hoda Asmar, MD, MBA, executive vice president and chief clinical officer at Providence. "We have made significant strides, and we will continue to make strides. This is something we are going to be working on for years to come, and we are saving lives."

Asmar says Providence focused on two processes during the first two years:

• The health system has more than doubled use of a standardized order set for sepsis patients. The primary elements are blood work and tests used to diagnose sepsis, administration of antibiotics, intravenous fluid resuscitation, and management of hypotension. Providence now uses the order set for 76% of patients presenting with sepsis and hopes to raise that rate to 80%.
   
• The health system is also setting a goal to have the first antibiotic administered within one hour of identifying a patient with sepsis. It’s currently meeting this goal for 77% of patients, with a target of 80%.

Asmar says those efforts helped reduce sepsis deaths from 2021 through 2023.

"Our end goal is to be at a rate better than expected mortality," she says. "The way we measure sepsis mortality is the ratio between observed mortality and expected mortality. The expected mortality comes from a benchmark based on the acuity of the patients we see. We want to be better than 1.0 on the sepsis mortality ratio of observed mortality and expected mortality."

In 2021, Providence ended the year with a sepsis mortality observed-to-expected ratio of 1.11. In 2022, that ratio was 1.04, and in 2023 the ratio was 0.90.

Last year, the health system saved an estimated 1,250 lives of sepsis patients, Asmar says.

Hoda Asmar, MD, MBA, is executive vice president and chief clinical officer at Providence. Photo courtesy of Providence.

New plans to save more lives

Asmar says Providence is now focusing on four more areas to improve sepsis care:

• The health system is looking at gaps between its care performance and the Centers for Medicare & Medicaid Services' (CMS) sepsis bundle expectations, which include early antibiotic use, timing of blood cultures, fluid resuscitation, and management of hypotension.

• Providence is looking at sepsis care through a health equity lens. Nationally, several patient populations experience worse sepsis outcomes than white patients, including Black patients and Hispanic patients. The health system wants to solve the unique challenges of vulnerable populations and is working on educational tools in languages other than English. A primary goal is to educate vulnerable populations about sepsis and sepsis care such as seeking care early.
   
• The health system is also focusing on early intervention. The earlier that clinicians can identify sepsis and intervene, the fewer complications and deaths. Providence is focusing on key settings such as emergency departments and urgent care centers. One strategy involves using the EHR to monitor vital signs such as blood pressure, heart rate, and respiratory rate and give clinicians an early warning when sepsis is detected.
   
• Providence is also using the EHR to manage care for patients who are admitted to a hospital for a different diagnosis but show signs of sepsis or septic shock.

"This is an ongoing journey," Asmar says. "There is not just one goal. We want to decrease harm and save lives. We are proud of our achievement in 2023, and 2024 is trending in the right direction to be below expected sepsis mortality."