Sepsis deaths prompt Allina health system to change

Faster identification and treatment of sepsis by Allina Health hospitals in Minnesota has reduced deaths from the infection-related condition.

Doctors and nurses at Allina started re-examining how they treat sepsis in 2014, after being dismayed at the number of deaths and learning that the condition was three times more lethal than strokes and heart attacks.

"Most people don't realize that," said Dr. Sandy Fritzlar, an ER doctor and medical director of Allina's sepsis program.

They found that too many cases weren't being detected quickly, because symptoms such as dizziness, elevated pulse and confusion are common to other conditions. And they found avoidable delays in two keys to sepsis treatment — fluid replacement to restore failing organs and antibiotics to fight underlying infections.

Hospitals statewide have confronted sepsis and joined the Minnesota Hospital Association's Seeing Sepsis campaign, which among other things encouraged clinicians to test for the condition when patients had temperatures and pulse rates above 100, or systolic blood pressures below that number.

Allina's approach is even more aggressive, screening all patients in its ERs who have infections and signs of organ dysfunction.

The system also eliminated an hourlong delay in lab results for lactate, a chemical in the blood that can indicate the severity of sepsis, by giving nurses a bedside test that produces results in minutes.

Allina also changed the pharmacy ordering system at its hospitals to prioritize antibiotics for sepsis treatment.

"We need to recognize this condition of sepsis early and deliver treatment rapidly," Fritzlar said.

One positive result is a reduction in septic shock, an often fatal condition in which blood pressure plummets and organs fail. The rate of sepsis patients who went into shock declined at Allina hospitals from 19 per 100 cases in early 2014 to 14 now.

Among patients who still suffered severe sepsis or shock, the death rate declined 30.3 percent since 2014 because of faster diagnosis and treatment.

All 11 of Allina's Minnesota hospitals ranked above the state average of providing timely and appropriate care for 45 percent of sepsis patients, according to federal Hospital Compare data for 2017. Regina Hospital in Hastings was tops, with 72 percent of its sepsis patients receiving appropriate care.

Allina's Abbott Northwestern Hospital in Minneapolis was involved in a high-profile death in 2013 involving a woman who had come to the ER with sepsis symptoms three days after giving birth. A lawsuit judgment awarded $20 million to the woman's family and faulted a nurse practitioner working at Abbott's ER for not picking up on the symptoms right away.

Allina officials said their campaign was independent of that incident. Delays in the delivery of sepsis care were identified through analysis of patient data by Allina's big data partner, Health Catalyst.

A next step in improving results is increasing public awareness, because many patients hesitate to come to the hospital until their sepsis cases are advanced, Fritzlar said.

"Some patients wait and wait and wait," she said, "to the point that they can't sit up and they have to call paramedics to lift them out of their beds."