Sepsis: Ohio Provides Hospitals with a Battle Plan

Hospitals and health systems looking for a blueprint for fighting the deadly disease should look to Ohio, where an aggressive campaign is being waged and mortality rates are falling.

The fight against sepsis is back in the news, but for those clinicians who spend their days combatting the deadly epidemic, the story never went away.

Health systems across the nation wrestle with a problem that the Centers for Disease Control and Prevention says is responsible for $24 billion in hospital costs each year.

The New War On Sepsis

Sepsis kills 258,000 people each year in the United States and costs more than $24 billion. It represents 6.2% of all hospital costs across the nation, which makes it the most expensive condition in the nation's healthcare system, according to the federal government's Healthcare Cost and Utilization Project.

HCUP analysis showed that while total hospital care expenditures have remained fairly stable, spending for sepsis rose 19% from 2011 to 2013, more than double the rate for all hospitalizations.

The study revealed that the mean expense per stay associated with those hospitalizations was over $18,000 in 2013, making hospitalizations from sepsis 70% more expensive than the average stay.

Sepsis resulted in nearly 1.3 million discharges that year from U.S. hospitals, an increase of 19% from 2011. Sepsis was also the most expensive hospital condition billed to Medicare, accounting for 8.2% of all Medicare costs incurred in 2013.

Hospitals and health systems that are looking for a blueprint for fighting the deadly disease should look to Ohio, where an aggressive campaign is being waged.

In 2015, Ohio's hospitals began a campaign to reduce sepsis encounters and related deaths by 30% by 2018. Less than one year after the initiative began, the Ohio Hospital Association reported an 8% reduction in mortality.

In 2012, the Buckeye State's 220 hospitals reported 26,299 encounters with severe sepsis and septic shock, resulting in 6,250 deaths. In 2015, those numbers had ballooned to 38,487 reported encounters and 7,478 deaths.

Of course, the reason why sepsis numbers are rapidly rising is because reporting systems such as ICD-10 have improved the ability to accurately report the infections, especially upon admission, which is where 80% of sepsis cases are traced.

But even with the proper context, the numbers are alarming and demand a response.

"Because we are encouraging people to identify it, we are not surprised that we have a more honest assessment of the problem in our state," says OHA President and CEO Mike Abrams.

"If we could go back and apply today's identification standards to the previous years, those numbers would be higher as well. The fact that we are better at identifying it is not the same as saying the problem is worsening."

Abrams says Ohio's hospitals in 2015 decided to "confront the brutal truths" and begin a campaign to reduce sepsis encounters and related deaths by 30% by 2018. Nine months into the initiative, OHA is reporting an 8% reduction in mortality. That's 353 lives saved.

"At every level of healthcare in our state, from CEOs to EMTs, ambulance workers and everything in between, we are trying to make sure that everyone in the system is more capable of identifying sepsis," Abrams says.

"We want to make sure they are curious about whether a patient is septic or becoming septic, and once that status is ascertained that they know what to do. It is a condition that we know how to treat, but it is time-sensitive."

Ohio's Two-pronged Approach

In 2015, the OHA board adopted two sets of interventions for sepsis; one for leadership commitment, the other for organizational strategies.

Among the recommendations, hospital leaders are asked to provide the resources and visible, vocal promotion of an accountable culture of safety in support of sepsis reduction.

Organizationally, hospitals are asked to develop early identification and intervention processes for sepsis, and coordinate sepsis prevention across the care continuum.

"A lot of it is just a conscientiousness about the process. It is identifying these patients earlier," Abrams says. "This is not like we don't know what to do. This is a condition that lends itself to certain interventions that work. Get the proper antibiotics to these patients in a timely way."

Abrams says hospital leaders respond more assertively when they're shown how their sepsis numbers compare with competitor and peer hospitals.

"Just that act alone raises awareness and identifies it as something that merits leadership level attention," he says.

"Once they understand that 'this is a problem in our facility' and there are interventions that work, that clinical science tells us the three-hour bundle is an actual intervention that clinicians have identified, the hospitals can learn for themselves where things break down."

Ultimately, Abrams says OHA "wants to do for sepsis what we did for ventilator-associated pneumonia: Make them rare."

"Raise everyone's awareness that this is a condition that you need to be intellectually curious about. Once you have identified it, here is a known intervention that works," he says.

"There are all kinds of reasons why you should be curious about sepsis. One is the number of lives you are saving, but the other is the true economic cost to our system that this condition presents. We all need to be interested in this."