In 2012, Rory Staunton, a 12-year-old boy, obtained a scrape during a middle-school basketball game. His gym teacher promptly applied two Band-Aids to the cuts on his arm. However, within a day, Rory’s condition rapidly deteriorated. He experienced a high fever, vomiting, and leg pain. The emergency room staff at NYU Langone Health initially suspected dehydration and administered fluids and anti-nausea medicine. Unfortunately, by Friday, Rory was critically ill, and by Sunday, he tragically passed away due to severe septic shock.
Looking towards the present, Rory’s mother, Orlaith Staunton, is hopeful that change is on the horizon. She believes that fewer tragedies like Rory’s will occur in the future. The Centers for Disease Control and Prevention (CDC) has recently released new guidelines aimed at assisting hospitals in quickly detecting and treating cases of sepsis.
The 35-page document, referred to as a road map, outlines the “core elements” necessary for a hospital sepsis program. Its purpose is to help administrators bring together experts from various medical disciplines to ensure swift detection and treatment of sepsis. Dr. Raymund Dantes, a CDC medical adviser involved in designing the guidelines, explains that they complement clinical guidelines by providing a detailed framework for equipping healthcare workers on the front lines.
Dr. Chris DeRienzo, the chief physician at the American Hospital Association, likened the recommended interdepartmental sepsis group to a well-coordinated NASCAR pit crew. These teams should act rapidly at the first signs of sepsis and resemble other code teams within hospitals.
Sepsis, an extreme immune response to an infection, can lead to tissue damage, organ failure, and death. Alarmingly, approximately one in three individuals who die in a hospital had sepsis during their stay. In the United States, around 1.7 million adults develop sepsis annually, resulting in approximately 350,000 deaths or transfers to hospice care.
Despite its prevalence, sepsis is often misdiagnosed by hospitals due to its symptoms resembling common ailments. As Dr. Hallie Prescott, a sepsis expert at the University of Michigan, explains, symptoms such as fevers, shivering, clamminess, and shortness of breath mask the illness. Additionally, detecting and managing sepsis requires coordination across departments and disciplines, which is often lacking in many healthcare settings.
A recent survey conducted by the CDC revealed that approximately 73% of hospitals have sepsis teams, but only 55% have designated leaders to manage these programs. Moreover, only half of hospitals integrate their sepsis programs with antibiotic stewardship initiatives, despite the crucial role antibiotics play in recovery.
The CDC’s guidance delves into best practices for implementing sepsis programs in various hospital settings, including large systems and small rural facilities. It covers personnel allocation, financial resource management, process improvement for case identification, and staff training to recognize symptoms. For optimal results, the agency recommends including experts from departments such as antimicrobial stewardship, the emergency room, infectious disease, and pharmacy. It is crucial for a doctor and nurse to jointly lead these programs.
Every hospital should establish a well-rehearsed “code sepsis” protocol and employ a live dashboard to track metrics related to case management and outcomes. Dr. DeRienzo advises hospital administrators to view the CDC’s road map as scaffolding upon which to build a tailored program that suits their local context.
To aid implementation, the CDC offers a detailed assessment tool that can be applied to specific settings. Additionally, the agency provides a list of initial steps for the 1,400 hospitals in the United States that need to develop sepsis programs from scratch.
While Rory’s mother acknowledges that the federal guidance falls short of the state regulations they championed after Rory’s death, she remains hopeful. In 2013, New York became the first state to require all hospitals to adopt sepsis protocols, known as “Rory’s regulations.” She believes that the new CDC guidelines, for which she advocated for years, won’t be overlooked by hospital administrators.
Ms. Staunton reflects, “It’s too late for Rory,” but emphasizes that there is hope for the millions of individuals predicted to die of sepsis in the next decade. She mourns the experiences her son never had, such as graduating high school, attending college, or having a girlfriend. If the CDC guidelines had been in place eleven years ago when Rory was in a major New York City hospital, perhaps his fate would have been different.
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