ORLANDO, FL (IHI National Forum 2013) -- Aided by its strategic partnership with the Institute for Healthcare Improvement (IHI), the North Shore-LIJ Health System reported today that it has reduced sepsis mortality in its hospitals by 50 percent over the past four years.
“We have reduced the sepsis mortality rate in our health system from 31 percent in 2009 to about 15 percent today,” said Martin Doerfler, MD, senior vice president of clinical strategy and development at North Shore-LIJ. “With the number of patients that we have as a very large health system (more than 260,000 hospital discharges in 2012), that translates into several thousand lives that have been saved over the past four years through the work we have done internally and through our partnership with IHI.”
Sepsis kills an estimated 200,000 Americans every year – more than most cancers, strokes and heart attacks. Recognizing the severity of the problem, North Shore-LIJ Health System President and CEO Michael Dowling launched a campaign to combat the problem in 2009, when clinical leaders from throughout the health system began partnering with scientists at North Shore-LIJ’s Feinstein Institute for Medical Research to identify patients in the earliest stages of sepsis and collect blood samples for research in a collaborative campaign to understand the condition and figure out ways to reduce the risk of death.
A year later in 2010, the Feinstein Institute hosted the Merinoff Symposium, bringing together more than 150 scientists, physicians, policymakers and other sepsis experts from 18 different countries to increase awareness of sepsis. The international conference created the first worldwide consensus on how to define sepsis and best practices to fight the disease – two critical steps in bringing the once-hidden killer out into the open.
In 2011, North Shore-LIJ’s campaign against sepsis ramped even further when the health system and the IHI established a strategic alliance to test new ways to prevent sepsis and manage its most harmful effects through earlier recognition. “When we began to partner with IHI, we really accelerated the pace of improvement as we expanded the IHI’s collaborative methods to 12 of the health system’s 16 hospitals,” said Dr. Doerfler, noting that the effort did not include North Shore-LIJ’s children’s, psychiatric or affiliated hospitals. Dr. Doerfler and John D’Angelo, MD, the health system’s senior vice president of emergency medicine, will be part of a team of clinicians from North Shore-LIJ that will be presenting Wednesday, Dec. 11 at the 25th IHI National Forum on Quality Improvement on how their work with the IHI in hospital emergency departments and medical/surgical units has improved process measures and clinical outcomes.
Through its collaboration with IHI, North Shore-LIJ developed highly reliable processes to expedite the treatment of patients with all forms of sepsis. Under the leadership of Dr. D’Angelo, all of North Shore-LIJ’s 12 emergency departments (ED) have been testing and reengineering processes to:
- decrease “door-to-doctor time” in the ED;
- identify and remove impediments to the administration of early antibiotics;
- track and modify processes to get lactate test results back to the physicians within 90 minutes of the patient presenting; and
- start fluids quickly with appropriate volumes given.
Similar processes were put in place in the health system’s medical/surgical units to promote early detection and aggressive treatment. To decrease the time it takes to identify patients at risk of sepsis, North Shore-LIJ screens patients with an infection who have two or more of the following: elevated or lower-than-normal body temperature, a heart rate greater than 90, a respiratory rate greater than 20, altered mental status or elevated white blood cell count.
Once patients are diagnosed with sepsis, the immediate focus turns to treatment. Treatment guidelines established by the Surviving Sepsis Campaign – an initiative of the European Society of Intensive Care Medicine, the International Sepsis Forum (ISF) and the Society of Critical Care Medicine -- call for patients to receive antibiotics within 180 minutes of when a septic patient presents at an Emergency Department. North Shore-LIJ has taken a more aggressive stance, with a goal of administering antibiotics to severe septic patients within 60 minutes.
Another underlying problem with sepsis is the lack of public awareness of the condition. Tragically, the 2012 death of a 12-year-old New York City boy, Rory Staunton, helped put the spotlight on sepsis. Rory had cut his arm diving for a basketball at his school gym. The next day, he arrived at his pediatrician’s office, vomiting, feverish and with pain in his leg. He was later sent to a local hospital emergency room. The doctors all concluded he was suffering from an upset stomach and dehydration. He was given fluids, told to take Tylenol and sent home. Three nights later, he died in a hospital’s intensive care unit. The cause was severe septic shock.
The Stauntons went searching for answers to prevent other families from having to go through the same ordeal. They ended up connecting with North Shore-LIJ. “I was introduced to the Staunton family soon after Rory died,” said Mr. Dowling, who was acquainted with Rory’s uncle. “They were understandably devastated by the loss of their child. Our clinical staff worked with them to figure out how we could put in place a check list that clinicians could use to flag those at risk of sepsis.”
Earlier this year, New York Governor Andrew Cuomo announced the statewide implementation of “Rory’s Regulations,” becoming the first state in the nation to require hospitals to adopt best practices for the early identification and treatment of sepsis. The guidelines in Rory’s Regulations relied heavily on best practices that North Shore-LIJ adapted based on its collaboration with IHI. In September, the Stauntons testified before Congress as part of an effort to implement similar measures at the federal level. They also established the Rory Staunton Foundation in their son’s memory.
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About North Shore-LIJ Health System
One of the nation’s largest integrated health care systems and the largest in New York State, North Shore-LIJ delivers world-class clinical care throughout the New York metropolitan area, pioneering research at The Feinstein Institute for Medical Research and a visionary approach to medical education highlighted by the Hofstra North Shore-LIJ School of Medicine. North Shore-LIJ cares for people at every stage of life at 16 hospitals and nearly 400 outpatient physician practices throughout the region. North Shore-LIJ’s owned hospitals and long-term care facilities house more than 6,000 beds, employ more than 10,000 nurses and have affiliations with more than 9,400 physicians. With a workforce of more than 47,000, North Shore-LIJ is the largest private employer in New York State. For more information, go to www.northshorelij.com.