Emergency room-ICU collaboration key to better sepsis outcomes

Lowering the threshold for admitting sepsis patients to the ICU from the emergency department lowers mortality, lengths of ICU stays and transfers from intermediate care to intensive care, according to new research.

The study, conducted by Northwest Hospital community hospital and Lifebridge Critical Care in Randallstown, Maryland, was published in CHEST Journal, the publication of the American College of Chest Physicians.

The results were dramatic. Overall mortality declined by 45 percent, even with no decrease in the severity of illness. ICU length of stay fell 26 percent, and transfers from intermediate care to intensive care dropped by 67 percent. The study estimated annual cost savings of $2.29 million based on average ICU rates of $2,500 per day.

The study credited collaboration between the emergency department and ICU to lower the ICU admission thresholds and standardize ICU admission criteria for patients with sepsis.

"Although ICU level of care is costly, earlier inclusion of borderline patients may improve mortality," lead researcher Joseph Carrington, M.D., said in a study announcement. "It may also significantly decrease resource utilization, as our study found."

The findings could have a profound impact for hospitals, as sepsis is a major driver in hospital mortality and readmission rates.

The infection contributes to roughly half of all U.S. hospital deaths despite being present in only 1 in 10 patients, FierceHealthcare previously reported. Sepsis accounts for as many readmissions and deaths as heart attacks and congestive heart failure, both of which are monitored closely under the Affordable Care Act. It also costs twice as much to treat as the other two combined, research has shown.

Part of the problem may be that the blood infection doesn't fall cleanly under a typical hospital department such as cardiology or respiratory care. "No one really owns" treatment of the condition, Martin Doerfler, M.D., senior vice president of clinical strategy and development at New York's North Shore-LIJ Health System, previously told FierceHealthcare.

A separate study also found that collaboration between the ED and ICU improved mortality rates among patients with sepsis. In that study, Kennedy Health System in New Jersey followed an evidence-based care model to implement new processes across the hospital to use in detecting and treating sepsis.

To learn more:
- read the study abstract
- here's the announcement

Related Articles:
Sepsis contributes to half of hospital deaths
Sepsis major driver of readmissions, mortality and costs
The sepsis threat: Why it's more 'insidious' than other conditions
Evidence-based care, culture change reduced sepsis, complications at NJ hospital
Critics complain proposed sepsis reporting rules could lead to overtreatment
Researchers use data for early sepsis detection

 

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