The Bad News on Sepsis is Really Good News

Cheryl Clark, for HealthLeaders Media , March 20, 2014

The debunking of a standard protocol for treating sepsis should not mask the great progress hospitals and clinicians have made over the last dozen years—or reduce the focus on sepsis.

This week's plot twist in the story about how hospitals deal with patients diagnosed with sepsis and septic shock may seem to many clinicians like more bad news: A protocol embedded in a nationally endorsed practice guideline didn't work better at saving lives than letting physicians use their best judgment.

True, most agree that there are problems with parts of that protocol, and the National Quality Forum and the New York State Department of Health, which is enacting reporting regulations throughout that state's hospitals, will have to go back to the drawing board.

But this is hardly cause for gloom. In fact, it is actually great news because it starts to clear the air, enabling us to see a better pathway to manage this terrible form of infection, a syndrome so thoroughly awful that the 750,000 to 1.1 million patients in the U.S. who are diagnosed with it each year are often said to be "circling the drain" because of sepsis' rapid corkscrew cascade.

And, by the way, sepsis costs the healthcare system in this country an estimated $17 billion a year because of added stays in intensive care and multiple desperation strategies to salvage failing organs.

This study, published online in the New England Journal of Medicine on Tuesday, will surely help clinicians improve their recognition and management of sepsis, which is hard to see early and extremely difficult to manage late.

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2 comments on "The Bad News on Sepsis is Really Good News"

andrew gerety (6/29/2014 at 8:18 PM)
metabolic theory of septic shock

Joseph M. Smith, MD, PhD (3/20/2014 at 9:02 PM)
As with the results of any well-done study (whether positive or negative), the knowledge propels us further down the road of continuous improvement. I was struck by the goal of getting appropriate antibiotics to the patient WITHIN 3 HOURS and couldn't help but note the contrast provided by today's NYT blog on "The Diminishing Returns of Modern Medicine" by Sandeep Juahar, MD. He points out that with intense focus it has been possible to shrink the door-to-balloon (D2B) time for coronary angioplasty from 83 minutes to 67 minutes - though it did not alter short-term mortality. When one considers the logistical challenges of getting a patient from the door of the ER though the subsequent maze of diagnostics, calling in a team of technical professionals (often from their homes) to work together in a specialized facility to perform a high-risk and meticulous invasive intervention, its quite a logistical feat to get this all done in nearly an hour. How could it be then that we are willing to set the bar for starting the appropriate antibiotic (a potentially more impactful intervention in a very high-risk cohort, with seemingly many fewer logistical challenges) at 3 HOURS? Our progress with D2B time (even now to a point a potentially diminishing returns) should help us to see that with focus, we can greatly streamline the logistics of care delivery. Seems time to put that same focus on door-to-therapy time for antibiotics in sepsis.




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