Shifting the Sepsis Paradigm

Houston Methodist Hospital’s ongoing, innovative and unique sepsis initiatives have reduced mortality from 35% to 6%.

Derived from the Greek word sipsi — to make rotten — sepsis was first introduced as a medical condition by Hippocrates. Sepsis isn’t merely an infection in the blood, it’s a systemic chain reaction triggered by that infection.

Two famous deaths now attributed to sepsis are Richard the Lionheart in 1199 following an arrow wound, and Lucretia Borgia in 1519 after delivering her second child. It wasn’t until 1869, though, when two Alsatian physicians, Victor Felz and Léon Coze, showed the blood of a patient with puerperal fever to be infected with bacteria. The observation was confirmed in 1879 by Louis Pasteur.

Today, sepsis remains one of the most insidious diseases facing hospitals.

Improved understanding of the pathology of sepsis in recent decades has advanced diagnosis and management of the disease. No longer attributed to only the infectious agent and subsequent immune response, medicine currently defines sepsis as a systemic immunological response to infection with significant alterations in coagulation, immunosuppression and organ dysfunction. Therapeutic interventions now include antibiotics, hemodynamic optimization and appropriate supportive care. While goal-directed therapies have improved patient outcomes, sepsis remains a killer worldwide. The Global Sepsis Alliance (GSA) is a charity organization with the mission to provide global leadership in reducing the worldwide burden of sepsis. After coordinated efforts with clinicians and families from more than 70 countries, the GSA’s efforts were fruitful in 2017 when the World Health Assembly and the World Health Organization adopted a resolution on sepsis to designate it a global health priority.

“Worldwide, sepsis is one of the most common deadly diseases, and it is one of the few conditions to strike with equal ferocity in resource-poor areas and in the developed world,” said Konrad Reinhart, MD, Founding President of the Global Sepsis Alliance. “When sepsis is quickly recognized and treated, lives are saved but health care providers need better training because they are the critical link to preventing, recognizing and treating sepsis.” In 2005, 12 years before the WHO resolution, Houston Methodist prioritized sepsis detection and management in its ICUs. In 2007, the focus shifted to designing a program for nurses to enable early recognition of patients with possible signs of sepsis, and ensure prompt, evidence-based interventions for diagnosis and treatment. Backed by organizational commitment and data-based leadership, this First Acute Care Sepsis Nurse Practitioner program was developed and integrated as an early sepsis screening tool into the electronic health record, which created screening and response protocols, to educate and train nurses. Houston Methodist evolved the nurse practitioner program into SERRI (Sepsis Early Recognition and Response Initiative), which, through federal funding in 2012, expanded to improve sepsis management in the 15 Texas facilities comprising the Texas Gulf Coast Sepsis Network. SERRI expanded further in 2016 with a $14.4 million grant from the U.S. Department of Health & Human Services Health Care Innovation Awards program.

Since implementation of the sepsis initiative, Houston Methodist has successfully reduced mortality from 35% to 6%, with nearly 2,500 lives and approximately $50 million in medical costs saved. Pivotal to this success rate is the 15 years of monthly data collection. Not only does having continuous data improve patient outcomes; it also keeps staff invested. “We're able to engage everybody because we can show our whole hospital staff, 'Hey, your work is making a difference on patients’ survival,'" said Faisal N. Masud, MD, Mary A. and M. Samuel Daffin, Sr. Centennial Chair in Anesthesia and Critical Care, medical director of the Center for Critical Care and Vice Chair for Quality and Patient Safety at Houston Methodist, Also of paramount importance are continuing education efforts, for healthcare providers and patients. In the absence of a single sepsis predictor or indicator, physicians and nurses must watch out for any number of symptoms that alone or together could indicate the presence of the deadly disease. And because it can be so easily missed, patients should feel confident in advocating for themselves. Masud advises people who aren’t recovering from an illness or infection as much as they should be, to feel free to ask their provider if sepsis could be to blame. Starting that conversation will get people thinking, and if sepsis is present, treatment can begin before it progresses too far.

Houston Methodist’s ongoing efforts also include an annual Sepsis Symposium in September, in recognition of World Sepsis Day. The symposium features diverse speakers across various key sepsis topics to increase healthcare provider competency and performance. Exemplifying Houston Methodist’s dedication to improving patient outcomes, this program, and its successes, demonstrate a level of commitment to sepsis management not seen in most hospitals. In fact, Houston Methodist Hospital is the only U.S. medical facility to be recognized by the GSA through their awards program honoring “outstanding efforts to increase sepsis awareness and raise the quality of sepsis prevention and management worldwide.” Still, a study published in the Lancet in 2020 reported that sepsis affects an estimated 49 million people resulting in 11 million deaths, globally, each year. One out of three hospital deaths are sepsis-related, and it is the single greatest cause of hospital readmission. To combat this increasing public health threat, the Centers for Disease Control and Prevention recently announced its Hospital Sepsis Program Core Elements, an initiative to support U.S. hospitals to more effectively manage sepsis and improve patient outcomes. Masud hopes that Houston Methodist’s progress will encourage other hospitals to address the sepsis crisis more proactively. “Everybody can do it,” he said, “It is possible, and it is manageable, but we have to commit to it. That's the only way.”

Heather Lander, PhD

December 2023

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