Health » Strict adherence to treatment plan drives decline in sepsis-related deaths.
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It started with a bad cough. But by the time Cleon Davies checked into Intermountain Medical Center's emergency room last February, he was in septic shock, breathless and in extreme pain, his heart pounding and blood pressure dangerously low.
The 69-year-old doesn't remember being rushed to intensive care where, using a 11-step treatment plan, doctors were able to save his life. He only recalls thinking, upon waking three days later, "Why do they need all these doctors? Sure seems like a waste."
But strict adherence to the protocol at two Intermountain Healthcare Hospitals has driven a sharp decline in sepsis-related deaths, setting a new standard for care, a new study shows. "We've shown it's possible to improve the mortality rate beyond where we ever thought possible," said IHC emergency-room doctor Todd Allen.
Allen will share his findings today at the Society for Academic Emergency Medicine's annual meeting in Phoenix, Ariz.
Sepsis strikes more than half a million Americans a year. It is a serious condition in which the bloodstream is overwhelmed by bacteria, usually from an ordinary infection like pneumonia, as with Davies, or a urinary tract infection. Blood pressure and oxygen levels drop and eventually lead to complete organ failure. Death can happen quickly, in up to 60 percent of patients -- a figure Intermountain Healthcare has driven down to just more than 10 percent.
Sepsis can be hard to identify, and once spotted, tough to treat, especially if discovered too late, said Allen.
Like many patients, Davies, a cancer survivor with congestive heart failure, arrived at Intermountain after ignoring symptoms for some time, said his wife, Joyce. "He's the sort of person who hates hospitals, so when he told me it was time to go, I knew he was really sick," she said.
The 11-step treatment "bundle" adopted by Intermountain Healthcare was developed in Europe, and has shown promising results. It includes pumping patients with fluids and broad-spectrum antibiotics until blood cultures point to more specific antibiotic treatments. It dictates the use of ventilators, steroids and monitoring of blood sugar levels.
In mid-2004, IHC's governing board decided to test and study the bundle with all severely septic patients over age 18, except pregnant women, at Intermountain Medical Center in Murray and LDS Hospital in Salt Lake City.
Compliance that first year was low. Medical teams used all 11 steps just 22 percent of the time. But each year compliance improved and fewer and fewer patients died. In 2008-09, full compliance reached 48 percent and mortality fell to 10.3 percent -- a decline of 80 percent, compared to some national averages.
This year, doctors got it right 71 percent of the time, equating to 100 lives saved, said Allen. "We've set a new bar for compliance and new floor for mortality."
Ulrich Schmidt, medical director of the surgical ICU at Massachusetts General Hospital in Boston, agrees Intermountain's compliance rates are "amazing."
Compliance to bundles is normally in the 40 percent range, at best, said Schmidt who has run similar experiments at his hospital.
But because IHC's study spans such a long time, it's hard to prove the bundles are wholly responsible, Schmidt said, noting how staffing ratios, the patient mix and other hospital guidelines could have changed. "I would need to see more data [controlling for those factors]," he said.