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by Russell Mayne
Published on January 16, 2017

It’s common knowledge by now that heart disease is the number one cause of death in the United States with cancer residing at number two. But what about the condition that is more common than a heart attack and claims more lives than any cancer? Sepsis may not get the national attention that heart disease and cancer receive, but that doesn’t decrease its severity. Sepsis is the number three cause of death in the U.S. and a viable contestant for the number one cause of death in the world – especially in underdeveloped countries – for children under the age of five.

Cerner acknowledges sepsis as a leading cause of death and has been striving to bring awareness and solutions to communities near and far to help understand and combat this global health care problem. But first, let’s take a deeper look into what sepsis is, so that we can better understand diagnosis and treatment.

An introduction to sepsis

Sepsis occurs as a complication from an infection and can be potentially life threatening. It is an inflammatory response triggered by chemicals released into the bloodstream to fight the infection. This inflammation can potentially trigger several physiological changes, which can result in damage to multiple organ systems, causing them to fail1.

The State of Qatar has instituted a system to ensure that clinicians are immediately alerted to patients at risk for sepsis. This early warning alert, in conjunction with the world class care available at Hamad Medical Corporation (HMC) hospitals, will reduce the number of patients progressing to sepsis.

A by-the-numbers look at sepsis

Despite advances in supportive care and disease-specific treatment, between 32 and 40 percent of all patients who develop sepsis will die in hospital2. In the United Kingdom, it is estimated that between 37,000 and 64,000 people die each year from sepsis3,4. Although anyone can develop sepsis, patients with pre-existing medical conditions, infections, a weak immune system, severe injuries, or those who are already hospitalized, are at the greatest risk. Patients with sepsis may have low blood pressure, decreased urine output, high or low body temperature, acidosis, fast heart rate, altered mental state and a skin rash. They may also have problems breathing. Sepsis is suspected when patients develop one or more of the above symptoms, and have a combination of a high or low white cell count, low platelet count, impaired liver and kidney function, or an infection in the blood. The risk of death rises six to 10 percent every hour from the onset of septic shock and the start of treatment5. Patients are more likely to survive if they are diagnosed early and treatment is started promptly.

A life-saving solution

Although clinicians are trained to identify early signs of sepsis and to provide treatment following evidence-based clinical pathways, sepsis symptoms can be subtle, not immediately obvious and difficult to identify. Storing medical records on traditional paper-based noting systems makes identification of these changes more challenging. For instance, lab results being paper-based and patient vital signs being documented in the paper nursing notes, may delay quick detection and diagnosis. As a result, the ideal window of opportunity to start early treatment may be lost.

Cerner, the provider of HMC’s clinical information system, is focusing on creating an environment where preventable events that may harm patients, are identified and highlighted to the appropriate caregivers in real-time. Cerner has developed a solution to meet the needs of expediting the accurate diagnosis and appropriate treatment of sepsis.

Supported with initiatives published by the Institute for Healthcare Improvement, The Joint Commission and Centers for Medicare and Medicaid Services, Cerner’s sepsis algorithm helps hospitals to eliminate a preventable cause of patient morbidity, mortality, and expense.

Cerner has developed an evidence-based algorithm allowing early intervention for patients at risk, and preventing deterioration into severe sepsis.

St. John Sepsis Agent: a potential life-saving algorithm

The St. John sepsis algorithm continuously monitors key clinical indicators and attempts to recognize a potentially septic pattern. When the algorithm detects a risk condition, it alerts those in charge of the patient, indicating the need to take action in order to prevent the condition from developing or progressing undetected. Recent data from HMC has found that the Sepsis Agent alerted the clinical teams at the first sign of patient deterioration over 3,000 times within the first six months of 2016. These alerts ensured clinicians were able to assess their patient for risk of sepsis and take immediate action to prevent further deterioration.

Quality and performance improvement

Constant monitoring for sepsis in real time, through the clinical information system, is now standard protocol through all HMC hospitals, ensuring that more patients receive timely care. In addition to the implementation of the St. John Sepsis Agent, HMC has initiated a corporate committee to ensure that world leading sepsis practices are standardized, adopted, implemented and evaluated across the system. HMC continues to leverage their investment in healthcare IT to improve patient outcomes and provide a worldclass service to the State of Qatar.

Credits:

1 http://www.mayoclinic.org/diseases-conditions/sepsis/home/ovc-20169784. 1 http://www.survivingsepsis.org/background/Pages/default.aspx. 2 http://www.msps.es/estadEstudios/estadisticas/cmbd.htm (in Spanish). Last available CMBD, 2010. DRG:Diagnosis-Related Groups. 3 The UK Sepsis Group, UK 2012. http://www.uksepsis.org/#/what-is-sepsis/3852800. 4 Dr Sanjoy Shah, Dr Tamas Szakmany, et al. Sepsis:The Extent of the Problem. The Critical Care Alliance. 16 December 2011. http://www.publicservice.co.uk/article.asp?publication=UK%20Science%20and%20Technology&id=546&-content_name=Health&article=18482 5 Technology Strategy Board, Detection and Identification of Infectious Agents. https://connect.innovateuk.org/c/document_library/get_file?folderId=3026452&name=DLFE-51469.pdf

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