Palo Alto VA aims to curb deaths from sepsis

A blue bus parked outside the Palo Alto Veteran Affair’s Medical Center on Miranda Avenue has been the center of a statewide program that aims to change the way hospitals approach treatment of sepsis.

Sepsis is a potentially fatal condition caused by a bacterial infection that leads to an inflammatory state throughout the body which can eventually damage and shut down entire organ systems. Every year, 750,000 people in the United States contract sepsis, according to the National Institute of General Medical Sciences. It’s been estimated that between 28 and 50 percent of these people die, which is more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined.

Thirteen health care teams at the Palo Alto VA were put through a sepsis education program that featured the SimSuite bus, a vehicle equipped with a high-tech mannequin that can simulate the symptoms of a sepsis patient such as low blood pressure, fever and rapid heart rate.

Dr. Stephen Scherr of the VA said he believes the simulation program will ultimately train hospital workers to better recognize sepsis early on.

“What these campaigns do is try to organize the ERs, the doctors and the nurses, the teams of care providers to recognize (sepsis), and then aggressively go after it and treat it with aggressive fluids, aggressive antibiotics, aggressive infection control,” said Scherr, who participated in the training program. “That’s the whole focus of this training, is to get people on the same page, get them to recognize it and go after it.”

Scherr said that there has sometimes been a varied approach to the treatment of sepsis at the VA.

“I think that among some people you would have aggressiveness and other people would take a more laid-back approach … what we’re trying to do is get ourselves more coordinated with that aggressive care to drive the mortality rates down,” he said.

The program’s involvement at the VA began earlier this year, when two staff members were sent to San Francisco General Hospital to experience SimSuite’s traveling sepsis training program, which has been hosted at more than 60 hospitals in California. They said they were “blown away.”

“We thought it would be a very good tool to bring here,” said Gloria Martinez, associate director of patient care and nursing services for the VA. “Looking at prevention, education, team training — looking at bundles in terms of grouping of symptoms, things like that … so that’s when we said, let’s take the opportunity to bring it here.”

Statewide mortality rates from sepsis have declined from 2011 to 2012, going from 17.43 percent in the first quarter of the calendar year to 14.38 percent in the last quarter. The VA’s sepsis mortality rates have fluctuated from over 20 percent in 2011 to under 10 percent in the first and third quarter of 2012, before resting at 16.22 percent in the last quarter. The VA’s medical staff indicated that these numbers fall within reasonable expectations, with the fluctuations most likely having to do with seasonal changes.

The SimSuite program has been making a significant dent in those numbers, said Jo Coffaro, regional vice president for the Hospital Council of Northern and Central California, whose organization has helped to coordinate the program.

She said the goal is to reduce the sepsis mortality rate by 30 percent by the end of the year.

“We’ve already hit 21 (percent) within two years, so we are well away to hitting that three year mark,” she said. “Currently, we are starting to collect our numbers and data about our year three report — it’s going to blow those numbers out of the water.”

Scherr noted that sepsis statistics can sometimes be misleading. It can also sometimes cause a condition called septic shock, when patients typically experience a critical drop in blood pressure and rapid increase in heart rate, leading to organ failure which is usually fatal. Septic shock mortality rates are much higher, around 60 percent.

Scherr, who said he has seen his share of sepsis cases at the VA, considers communication and taking immediate action crucial to effective treatment.

“When you’re talking sepsis, you’re talking the sickest of the sick,” Scherr said. “If you come in with a sniffle cold you’re not septic, you just have a cold. But when we’re talking septic patients, they have blood infections, skin infections, lung infections that are going to kill them, and you’re trying to reverse that slide towards death. What you do does matter, so that’s why you really want to intervene in as aggressive manner as possible.”

Scherr and Ellman said that part of the reason the sepsis program is effective is because it brings together many different hospital departments.

“It’s a unique training because it’s cross departmental and interdisciplinary, which is very rare,” Ellman said. “You normally have nurse teams working on something or physician teams … we’re basically covering the health care system, so it’s emergency personnel as well as the intensive care personnel all together.”

Navy veteran David Renfro, chief nurse at the VA, said the hospital’s research team — which is currently looking at sepsis — also participated in the program.

“Like many facilities, we shoot for zero everything,” Renfro said. “This is one of those elements that we shoot for zero everything. Even though we are very comparable to our region, we always want to excel and do the best for our veterans.”