Friday, September 7, 2018

'Could this be sepsis?'

Graphic courtesy of the Rory Staunton Foundation

Sepsis is a disease that kills more than 258,000 Americans each year – that is more than prostate cancer, breast cancer and AIDS combined. It is the leading cause of death in hospitals, however nearly 80 percent of sepsis cases develop outside of a hospital. Yet, for a disease that is so common and deadly, less than half of Americans have ever heard of sepsis.

“There has never been a major public education campaign for sepsis, so it has always flown under the radar,” says Michael Filbin, MD, MGH Emergency Medicine physician and leader of the MGH Sepsis Care Redesign and Partners HealthCare sepsis initiatives.

Causes, signs and symptoms

Sepsis can be caused by any type of bacterial, viral or fungal infection in the body, such as a cut or scrape, pneumonia, ulcers or a urinary tract infection. Sepsis is when the body’s response to fighting the infection goes wrong and overresponds, causing the immune system to attack its own organs and tissues.

“One of the issues with sepsis is the patient doesn’t always present with clear symptoms of infection,” Filbin says. “It can manifest in vague and insidious ways. In most cases patients are older or chronically ill, but it can just as easily hit the young and healthy.”

Though often difficult to pinpoint as sepsis, some of the warning signs include a fever, chills, rapid breathing, extreme pain, pale or mottled skin, elevated heart rate, and confusion or disorientation. If a person is experiencing any of these symptoms, Filbin says, they should ask themselves “could this be sepsis?” If diagnosed early, sepsis can be treated with antibiotics, IV fluids and close monitoring.

Treatment options

FILBIN

Early identification and diagnosis of sepsis is critical. For every hour that sepsis diagnosis and treatment is delayed, the risk of death increases considerably, Filbin says.

“As doctors, we are taught to base our decisions off diagnostic information,” he says. “With sepsis, it is not always possible to wait for that information. The tricky part sometimes is knowing when to pull the trigger on preemptive treatments.”

Sepsis also can lead to tissue damage and organ failure, and the patient may be dehydrated or have low blood pressure– all conditions that need to be taken into consideration during treatment. “

Antibiotics are the one intervention proven to decrease morbidity in sepsis patients,” Filbin says. “However, there is a whole suite of treatments that may be needed to fix organ dysfunction, among other things, so a lot of challenging decisions are involved in the process.”

Steps forward

“One thing that really strikes me is the tools we have to diagnose sepsis, treat it and monitor it have not changed in all my years in health care,”says Filbin. Although treatment is essentially the same as it was many years ago, there have been processes at the MGH to improve sepsis diagnosis.

Starting in 2014, Filbin partnered with other MGH clinicians and a Massachusetts Institute of Technology biomedical engineering team to analyze sepsis signs and create an algorithmic warning system to alert clinicians when a patient might have sepsis. This cut the length of time it takes to diagnose sepsis in half, leading to earlier antibiotic treatment.

As a result of this work, a purple flag appears in Epic to alert emergency clinicians to the possibility of sepsis. A best practice alert also was built into the electronic medical record, as well as a sepsis specific order set to help clinicians order the correct treatments. Filbin also is a co-chair of the MGH Sepsis Steering Committee – along with Emily Aaronson, MD, of Emergency Medicine; Kathryn Hibbert, MD, of Pulmonary and Critical Care Medicine; Colleen Snydeman, RN, PhD, director of the Nursing & Patient Care Services Office of Quality and Safety; and Michael Phillips, of the Center for Quality and Safety. The group of dedicated sepsis champions from each clinical department was formed two years ago and regularly meets to review sepsis care at the MGH with the goal of setting and improving standards of care for patients with sepsis.

“The most important thing we can do is educate everybody – the public, doctors, physician assistants, nurse practitioners and, most importantly, frontline nurses – to recognize the signs of sepsis and to understand how deadly it can be if not treated promptly,” Filbin says.



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