More than 49 million people develop sepsis each year, leading to approximately 11 million deaths across the globe. In the US, sepsis is the number one cause of hospital readmissions, and one in three people who die in a hospital had sepsis during their hospitalization.
Sepsis mortality rates average around 30 percent worldwide. But they vary greatly and can exceed 50 percent in low-income countries. Yet, as many as 80 percent of deaths due to sepsis could be avoided through rapid diagnosis and treatment.
As global health systems become increasingly aware of the wide-reaching impact of sepsis, medical laboratory professionals can play a key role in effectively diagnosing and treating the deadly infection.
Expert guidance for improving sepsis diagnosis and treatment
Ahead of World Sepsis Day on September 13, the Centers for Disease Control and Prevention (CDC) issued its new Hospital Sepsis Program Core Elements to provide guidance on developing a multidisciplinary hospital sepsis program. As hospitals look to establish or optimize their own processes associated with sepsis identification, here are three recommendations to aid medical lab professionals in these efforts:
1. Labs must take leadership in formal sepsis programs
Hospitals must develop a formal sepsis program as noted in the CDC’s Core Elements program. Ideally, a hospital's program would encompass all groups and specialties, and include an early screening process to detect sepsis as fast as possible. The majority of septic patients present to the emergency department (ED), and every hour of delayed treatment can increase mortality by up to 8 percent.
The clinical laboratory should play a vital role in any formal sepsis program. The lab’s leadership and guidance will help prioritize which patients get various tests, how fast results are turned around, and how these results are communicated to providers tasked with making clinical decisions. The information coming from the lab is a fundamental element in operationalizing a successful sepsis program.
2. Labs must connect with quality and safety initiatives
Sepsis programs should have direct connections to a hospital’s quality improvement and patient safety initiatives. Quality has been very involved in sepsis management due to Centers for Medicare & Medicaid Services (CMS) tracking of the compliance to the SEP-1 bundle. Recently, CMS announced that SEP-1 performance will become part of value-based purchasing, which will deepen quality incentives related to sepsis management. The lab can play a critical role here—early identification of sepsis can ensure a patient receives the right care at the right time. Having the proper testing and tools available in-house makes the lab a key partner in achieving these objectives.
3. Rapid sepsis identification tests are a must in the emergency department
Since most potentially septic patients present to the ED, where little information is available and definitive diagnostics are not present, their diagnosis may be missed, or non-septic patients may be overtreated. These misdiagnoses affect hospital metrics, such as ED wait times and SEP-1 compliance; hospital economics, including resource use and crowding; and patient care and outcomes.
The vast majority of sepsis deaths may be preventable with the right technology and tests. These exist for other conditions: troponin for ST-segment elevation myocardial infarction (STEMIs) and CT scans for strokes. Hospitals need a similar rapid test for sepsis, ideally one with a similar turnaround time of under 10 minutes. The test must deliver strong data that equips providers with the confidence to make decisions about what to do with patients that present signs of infection.
Emerging host response diagnostics like deformability cytometry may provide such a solution. As with troponin and other early breakthroughs, the clinical laboratory will play an important role in evaluating and adopting these new tests to support patient care, and incorporating new tests that support sepsis screening as part of the CDC’s Hospital Sepsis Program Core Elements.
Reducing sepsis mortality
Sepsis is among the most clinically and economically impactful conditions managed by hospitals. Enabling medical lab professionals to be more proactive in the diagnosis and treatment of sepsis is critical to reducing mortality. Having a multidisciplinary hospital approach and encouraging individual hospitals to employ their own sepsis reduction program starting at the point of entry and culminating in the lab is key to minimizing deaths related to sepsis.