Sepsis deaths a concern for Canadian hospitals

A new report focuses on efforts by Canadian hospitals to reduce more than 9,300 deaths each year from sepsis, a serious body-wide response to infection that patients often acquire while being treated in hospital.

TORONTO — A new report focuses on efforts by Canadian hospitals to reduce more than 9,300 deaths each year from sepsis, a serious body-wide response to infection that patients often acquire while being treated in hospital.

The report released Thursday by the Canadian Institute for Health Information looked at hospitals, not including those in Quebec, in 2008-2009, as part of an ongoing project to track hospital mortality.

It’s their first pan-Canadian snapshot of sepsis, one of the top causes of death in hospitals, said Indra Pulcins, director of indicators and performance measurement at the institute.

“We’ve looked at all hospitals, all HSMRs (hospital standardized mortality ratios) across the country, and done this analysis to shed more light on sepsis, what can be done, and what hospitals are doing about it,” she said.

They found that more than 30,500 patients were hospitalized with sepsis in the period studied, fewer than the number admitted for new heart attacks.

“One in three patients with sepsis in Canada will end up dying from it — so it’s about 30 per cent. Just to put this in context, the mortality rate for stroke was about one in five patients would die, for heart attacks, one in 10 patients would die,” Pulcins said.

There were no significant changes in either sepsis hospitalizations or sepsis mortality rates since 2004-05, the report found.

The condition can be difficult to diagnose and needs to be treated quickly with antibiotics, Pulcins said.

Signs of sepsis are fever or lower-than-usual temperature, rapid heart rate and breathing and an abnormally high or low number of white blood cells. As it gets worse, blood flow to vital organs can decline, and the kidneys, blood vessels and lung function can be affected.

Most infections don’t lead to sepsis, but people with weakened immune systems and certain chronic conditions are more vulnerable. The report found that sepsis patients with pre-existing illnesses had higher odds of dying.

Besides the human toll, there is a financial cost because the average length of a hospital stay is nine days longer for sepsis patients than for those admitted for other conditions.

“We can estimate that most hospitalizations cost around $5,200 for all conditions, and the average cost for a sepsis hospitalization was about six times higher,” Pulcins noted.

The study also looked at the efforts of three hospitals that are actively trying to reduce deaths from sepsis.

Southlake Regional Health Centre in Newmarket, Ont., launched an outreach team, whereby a nurse on a regular ward can call on the expertise of an intensive-care nurse and respiratory therapist to help do an assessment, said Barbara Kendrick, the hospital’s director of quality and planning.

“There are special skill sets that a critical-care nurse has and they also use different types of monitoring — they can bring that monitoring to the ward and provide their expertise and assessment to help that ward nurse,” she said in an interview.

“So rather than wait till the patient fails enough that everyone can recognize it and they go to the ICU, you’re trying to intervene earlier.”

A similar response team was created at St. Joseph’s Healthcare in Hamilton in 2007, and Dr. Roman Jaeschke says it has led to fewer sepsis patients going to the ICU.

Efforts undertaken at Calgary’s Foothills Medical Centre are also detailed.

“For every hour delay of sepsis shock before you get antibiotics on board, survival has been shown to decrease by 7.5 per cent,” emergency room Dr. Marc Francis says in the report.

New measures to identify and treat sepsis patients in the ER of the Calgary hospital have meant a mean reduction of 84 minutes in the time it takes to start antibiotics in severe sepsis, the report states, although Francis says whether it translates into fewer deaths remains to be seen.

The institute’s report found that the overall hospital standardized mortality ratios appear to be falling.

“It’s really the best time for patient safety in Canada because there’s so much attention on it, and hospitals are very much paying attention to it,” said Pulcins.