We read with great interest about the work reported in the Journal of Hospital Medicine, lead by Dr. Doerlfer and his co-researchers at the Icahn School of Medicine at Mount Sinai. It suggests that patients with hospital-presenting sepsis may receive less timely initial resuscitation. Could it be, in part, because of what we term the “data desert” in medical/surgical wards or that clinicians need more than singularly episodic vital signs and nursing observations? It appears that medical professionals must accomplish this in a way that neither disturbs the recuperating patient, nor the clinical workflow.
Northwell Health issued the following news release:
Martin E. Doerfler, MD, Northwell Health senior vice president of clinical strategy and development, has collaborated with investigators from the Icahn School of Medicine at Mount Sinai and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on a new study assessing the differences between hospital-presenting sepsis (HPS) and emergency department-presenting sepsis (EDPS), which, according to the researchers are historically not well delineated in both settings. The findings first appeared on April 8 in the Journal of Hospital Medicine, the official peer-reviewed journal of the Society of Hospital Medicine.
Sepsis is a body-wide immune system reaction to an infection that is responsible for more than 300,000 deaths in the United States each year and leaves many survivors profoundly disabled. The sepsis condition can lead to widespread inflammation and may result in organ dysfunction or failure. It is the most common cause of death in hospitals across the country and carries a significant financial burden. Dr. Doerfler and his co-researchers aimed to quantify the prevalence of Sepsis in both hospital and emergency room settings, compare their characteristics, process, and estimate the differences in risk as it pertains to patient outcomes.
"In an effort to continue finding solutions that curtail the concerning numbers of fatalities as a result of sepsis, we set out to explore how this condition manifests itself both in the in-patient and emergency room locales, and the various challenges associated with recognition, treatment and monitoring," said Dr. Doerfler, who is a member of The Feinstein Institute for Medical Research and is Northwell's associate chief medical officer. "As clinicians, we need to better to understand this knowledge gap so that we can correct the origins of the disparities."
EDPS had nearly twice the mortality odds
The group of researchers studied nine hospitals from October, 2014 to March, 2016, which included 11,182 hospitalized patients with sepsis or septic shock, and assessed overall HPS versus EDPS outcomes. The group concluded that hospital-presenting sepsis differed from emergency department-presenting sepsis by admission source, comorbidities, and clinical presentation. Based on the findings, the investigators argue that cases stemming from the inpatient setting accounted for adverse patient outcomes disproportionately to prevalence, with patients posing more complex scenarios and receiving timely antibiotics half as often as those presenting sepsis in emergency rooms. The study concluded that EDPS had nearly twice the mortality odds with resuscitation disparities explaining 25 percent of the difference.
"Dr. Doerfler and his colleagues shine much needed new light on sepsis occurring in hospitalized patients," said Kevin J. Tracey, MD, president and CEO of the Feinstein Institute. "Because minutes matter to save lives, these findings raise the bar to increase awareness of possible sepsis cases appearing in hospital wards, not just the ER."
Dr. Doerfler collaborated with Daniel E. Leisman, BS, corresponding author, and Catalina Angel, MPA, from the Icahn School of Medicine at Mount Sinai, and Sandra M. Schneider, MD, Jason A. D'Amore, MD, and John K. D'Angelo, MD from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Quick diagnosis is key
Identifying ways to combat sepsis is a major research priority for the Feinstein Institute and Northwell. Led by Dr. Doerfler, a Sepsis Task Force was created to help shorten the diagnosis time, which is a crucial element to preventing loss of life. The Task Force reviewed previous cases to identify the key signs for sepsis and identified a protocol that includes early administration of fluids and antibiotics to implement across Northwell's hospitals. As a result, sepsis-related mortalities were reduced by almost 70 percent.
In December 2018, Feinstein Institute assistant professor Monowar Aziz, PhD received a five-year, $1.68 million grant from the National Institutes of Health to examine a protein's role in increasing inflammation and injury in sepsis to develop new therapies, and in February, Steven Gurien, MD, a Northwell Health surgical resident and member of the Feinstein Institute, was honored by the Society of Critical Care Medicine for his efforts to pinpoint specific molecules that can reduce inflammation during sepsis.
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