Kaiser Permanente’s integrated system of doctors, hospitals and health plan enables us to identify best practices and standardize them in all Kaiser Permanente medical centers to systematically improve our performance. One example of how we are implementing standardized best practices is in the Northern California Region’s response to septicemia, a very serious infection more commonly known as sepsis.
Both the U.S. Department of Health and Human Services and the Partnership for Quality Care recently identified sepsis as the No.1 cause of death in U.S. hospitals, afflicting an estimated 750,000 people and resulting in 117,000 to 215,000 deaths 1. Any kind of infection — bacterial, viral, parasitic, or fungal — can trigger sepsis and the majority of the sepsis cases are patients who already contracted the infection prior to arriving at the hospital. The infection can develop quickly, so it’s critical that it is diagnosed and treated immediately.
In 2008, as a response to this public health crisis, Kaiser Permanente in Northern California developed an innovative program to screen and reliably provide effective treatments to hospital patients identified at risk for sepsis, such as the very old, very young, and people with pre-existing medical conditions who may be at greater risk. Since the implementation of the program, Kaiser Permanente Northern California has reduced mortality for patients admitted to hospitals with sepsis by more than 40 percent — and saved more than 1,400 lives.
The Kaiser Permanente Northern California initiative, Saving Lives Through Better Sepsis Care, focuses on several elements ideally achieved within the first six hours after a patient with sepsis arrives at the hospital — an approach that requires comprehensive training, teamwork, and coordination of care delivered in the emergency department, operating rooms, intensive care units and all other hospital units. Beginning the moment a patient enters the hospital, including at the moment of triage in the emergency department, staff identify patients who present signs of infection and the subtle abnormalities in vital signs that could signify sepsis.
In addition, a highly effective campaign to promote specific blood testing for sepsis in every patient hospitalized for an infection has increased the detection of sepsis significantly. The combined efforts — building awareness of the signs for sepsis, and increasing the amount of diagnostic testing — led to a 102-percent increase in the rate of sepsis detection in the Northern California hospitals in the first year of the program alone.
Early detection can then be followed by aggressive treatment, which involves identifying and eliminating the underlying infection with anti-infection agents or surgery to drain the site of infection, and the placement of a central venous catheter when appropriate. Depending on the patient’s condition, other treatments may include fluids, drugs to raise low blood pressure, mechanical ventilators to support breathing, or dialysis for kidney failure.
Kaiser Permanente’s Northern California hospitals have simulation mannequins, which are used to train emergency physicians in the placement of central intravenous catheters under ultrasound guidance to ensure that patients with sepsis have safe and timely central line placement in the emergency department. Under this program, central line monitoring in the first two hours after identification of sepsis has more than tripled.
The region also has built into Kaiser Permanente HealthConnect®, Kaiser Permanente’s electronic health record system, standardized orders, documentation tools, alerts and other means to prompt effective interventions for sepsis in all care settings. The computerized records also allow Kaiser Permanente’s Division of Research in Northern California to collaborate with clinical leaders to aggregate anonymous patient data and analyze the test results and clinical outcomes of thousands of sepsis patients. That analysis led to the identification of a subpopulation of patients who are at increased risk of developing an infection and require additional treatment and monitoring. As a result, the hospitals implemented follow-up testing and preemptive rounding programs to ensure this population improves as expected.
In addition to the significant reduction in deaths due to sepsis, the average length of stay for Kaiser Permanente Northern California patients with sepsis dropped by more than 17 percent in just one year after implementation of the program.
It has been estimated that if the U.S. as a whole achieved these kinds of results around sepsis identification and treatment, there would be 92,000 fewer deaths annually, 1.25 million fewer hospital days annually, and reductions in hospital expenditures of over $1.5 billion.2, 3
Kaiser Permanente’s Northern California program is unique in its successful adoption of a single standard of sepsis care across an entire hospital system in all units of care. Based on its successes, the program is now being introduced in all Kaiser Permanente hospitals.