Indy hospitals tackle sepsis, killer of Muhammad Ali

Most people know the early signs of heart attacks and strokes, two major killers. They are not as familiar with a medical condition that kills more than 258,000 people a year — sepsis.

Now, a group dedicated to improving patient safety hopes to change that. The Indiana Hospital Association’s Patient Safety Center has taken steps to reduce the number of deaths each year from sepsis, and it wants to enlist the general public in the initiative to bring that number down even more.

“The public now knows if you have a stroke or a heart attack, you need to get treatment,” said Carolyn Konfirst, Indiana Patient Safety Center clinical director. “Sepsis really is flying under the radar. I don’t know that everyone recognizes that it’s time-sensitive. … It’s not something that you can delay.”

In 2008, amid concerns about the high death rate from sepsis, the center — which works with local hospitals, providers and state agencies — started tracking the percentage of people diagnosed with sepsis who die from it. Sepsis occurs when the body releases chemicals into the bloodstream in an effort to overcome an infection. But instead of fighting the infection, that process spurs an inflammatory response that can lead to potentially deadly complications, such as organ failure and tissue damage. In the worst-case scenario, sepsis leads to shock, a condition in which blood pressure drops precipitously.

Eight years ago,15.22 percent of people admitted to hospitals in Indiana with sepsis, excluding those who were terminally ill, died from the condition. 

In 2015, that rate had dipped to 6.12 percent. In 2014, more than 3,240 people in Indiana died from sepsis. Experts say national numbers are hard to come by, but a national study published in 2014 found a sepsis mortality rate of 10.4 percent.

Last week, the safety center focused its annual meeting on bringing those numbers down even further. Collaborating and sharing best practices to identify and successfully treat sepsis early have helped the state’s hospitals decrease their sepsis mortality rates, local patient safety advocates say.

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“It has been a consistent focus. It hasn’t been 'let’s focus on this and then we will focus on that.' We’re going to focus on this until we get it fixed,” said Anita Keller, chief nursing officer of Johnson Memorial Hospital in Franklin.

Indiana is not alone. Nationwide there are more than 1 million cases of sepsis a year, and it is the ninth cause of disease-related deaths, according to the Centers for Disease Control and Prevention. Muhammad Ali’s death was due to sepsis, as was the March death of actress Patty Duke.

Sepsis cases may also be increasing as the population ages and more people have devices such as catheters and pumps implanted, which can increase the risk of infections, said Theresa Murray, network clinical nurse specialist for Community Health Network.

Even a seemingly minor infection can lead to sepsis, but those with compromised symptoms,  the elderly, and the very young are at higher risk. In sepsis, germs from the infection proliferate and can lead to a cascade of symptoms, including shaking and/or fever, pale skin, rapid breathing and heart rate, confusion, fatigue and intense pain.

Still, many providers don’t automatically consider sepsis when facing a patient in its early stages because it resembles many other diagnoses. A person in sepsis can deteriorate rapidly and there’s not much time to spare when it comes to recognizing and treating the condition.

“In the back of your mind there should always be the question, 'Could it be sepsis?' ” Konfirst said.

Broad spectrum antibiotics given as soon as possible represent the best defense against sepsis. In many cases, fluids and oxygen are needed to keep the patient’s oxygen and blood pressure as normal as possible.

In an effort to catch cases earlier, Johnson Memorial Hospital focused on increasing emergency room triage nurses’ awareness of sepsis symptoms, Keller said.

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Johnson Memorial also developed a sheet of “an awful green color” that patients admitted from the emergency room have in their chart, said Robert Hattabaugh, clinical nurse specialist at Johnson Memorial Hospital. That sheet contains checklists for what nurses need to look for — such as certain lab tests — to watch for and treat sepsis.

“It’s really moving your hospital or health care system to a culture of recognition or treatment,” Keller said.

Because about 40 percent of patients are admitted after an emergency room visit, Community Health Network took pains to ensure that a better handoff occurred from emergency room staff to those overseeing the patient care in the hospital, Murray said. The hospital also designated a rapid response nurse who screens patients daily for signs of sepsis and has the authority to initiate treatment if sepsis is suspected.

The most important challenges now, however, may be increasing public awareness of sepsis.

Often, people may not suspect sepsis lies behind symptoms because they do not see an obvious source of the infection. In about 30 percent of sepsis patients, the initial site of infection is not identified, Murray said.

People also need to realize that sepsis is serious.

“Even though it can be subtle, it’s still deadly,” Hattabaugh said.

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.