Sepsis 3

“Jaded Julie, I’ve read so many articles on sepsis in the past few weeks that my head is spinning.”

“I know you are confused most of the time, Curmudge, but do you have chills, a fever, or are you hyperventilating? Here, let me check your blood pressure.”

“No, Julie. I don’t have sepsis. It’s just that the articles are generally similar, and as a layperson, I wouldn’t understand subtle differences if I saw them. So from now on, I’m not going to sweat the details. I’ll leave them to the physicians and nurses. Our focus today will be on Affinity’s experience with sepsis, including diagnosis and management.”

“But we’ve already discussed diagnosis. Is there anything special that we do?”

“There is, Julie, and it’s a mannequin called iStan. iStan is the smartest dummy in town because he can be programmed to portray a vast array of symptoms of a host of diseases. For example, iStan’s software comes with a sepsis simulation scenario.”

“Well at least if he exhibits oliguria, there won’t be much of a puddle to clean up.”

“iStan is a new addition to our staff and has been used thus far for orientation of new hires. His use will grow as people get more familiar with his operation. I’m looking forward to being impressed whenever I can arrange a demonstration.”

“So what else is new, Curmudge? The links to Affinity documents in Sepsis 2 suggest that our hospitals are doing the right things in sepsis diagnosis and management.”

“There’s more to be told, Julie, but I promise…no clinical details. We have been using IHI’s Surviving Sepsis Guidelines since 2005 and the IHI Sepsis 6-Hour Resuscitation Bundle. These have been translated into pre-printed order sets, the Severe Sepsis Screening Tool and the Severe Sepsis Septic Shock Order Set: 6-Hour Resuscitation Bundle. If you read any of these, they would look pretty familiar.”

“And that’s the Lean standard work you were talking about. The value of these is that for severe sepsis and septic shock, one can’t afford to overlook any of the critical steps.”

“The ICU’s also use spreadsheets to track their compliance with each step in the resuscitation and management bundles for each patient.”

“Our procedures sound impressive, Curmudge. Are we saving lives?”

“I have some data from Mercy Medical Center, Julie. In 2004 the nation-wide mortality rate for sepsis was 28.6% (215,000 deaths). For MMC, the sepsis mortality rate was 11% in 2005-2006 and 6-7% in 2009. MMC treated 22 patients for sepsis from January 2011 through early August.”

“What might one do to avoid becoming a sepsis patient?”

“Avoid sepsis by avoiding infections. You and I talked about avoiding infections back on January 29, 2009. Although that posting was about nosocomial infections, one should also practice good hygiene at home. Teach your children about washing their hands and not neglecting a cut or scrape. If because of joint or other prior surgery you are directed to take a prophylactic med before having dental work, do it.”

“The mortality rate from sepsis in U.S. hospitals is worrisome enough. It’s undoubtedly higher in hospitals in the Third World.”

“One who travels to undeveloped countries should certainly have air-evacuation coverage in their trip insurance. If you contract sepsis in one of those strange-sounding places, your life may depend upon being airlifted out ASAP.”

“I understand that you found a valuable lesson in your reading last night. (Hey, Curmudge, get a life.)”

“The Smiths took their ill 7-year old son to the ED. Aside from nausea and a heart rate of 148, his vitals were normal. While he was at the ED his heart rate decreased and he was able to receive fluids. The Smiths wanted to leave, although results from the complete blood count were not yet back from the lab. The doctor, believing the child had a urinary tract infection, discharged the patient and told his parents that he should be better in 24 hours but to return if he is not.”

“I see impending trouble. What happened?”

“Within the next few hours, the child developed severe sepsis. He survived but suffered organ damage. The lesson: Stay with your sick child; lose a night’s sleep if necessary. If his condition deteriorates, don’t delay in returning to the ED. Incidentally, this scenario can occur with other illnesses such as appendicitis.”

“Actually Curmudge, that’s one of the perennial concerns of ER docs…that a patient will come in with a condition not well enough developed for a definitive diagnosis. Then the condition intensifies and clobbers the patient within 24 hours after he is sent home. So, Student of Medieval History, do you have a final perspective on sepsis?”

“Back in 1348 when the Black Death ravaged Europe, about three-fourths of the population of Great Britain died. The survivors were possibly not exposed to the sick people or the fleas carrying the disease, or perhaps they possessed a natural immunity. One of the three forms of the medieval plague was septicemic plague (the others were bubonic and pneumonic); its symptoms were similar to modern severe sepsis. In the 14th century, the mortality rate from septicemic plague was 99-100%. Patients sometimes died the same day they contracted the disease. The lesson: Sepsis was—and still is—a deadly condition.”

Affinity’s Kaizen Curmudgeon