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Each year, sepsis affects about 1.7 million adults in the United States and claims the lives of over 250,000.1 It occurs when the body has an exaggerated response to an infection that results in tissue damage and organ failure. Left unchecked, sepsis can cause a patient to quickly deteriorate and can lead to cardiac arrest, severe illness, and death. Studies also show that in-hospital cardiac arrest patients with underlying sepsis are less likely to survive than those without.2

The best defense against severe sepsis and sepsis-associated cardiac arrest is early identification and treatment. But why is early detection so important, and how can hospitals ensure they have the right systems in place to accomplish it? Keep reading to find out.

Why early identification of sepsis matters

When it comes to recognizing and treating sepsis, the operative word is early. Key components of sepsis care include3:

  • Awareness of the patient’s risk for sepsis and septic shock
  • Early identification of the infection
  • Early administration of antibiotics
  • Early fluid resuscitation

Put simply, prompt identification of sepsis gives patients the best chance of surviving sepsis or septic shock. And it makes sense: sepsis can quickly become life-threatening and is much harder to treat as it progresses. The sooner sepsis is identified, the sooner patients can begin receiving interventions to reverse it. Not only does early treatment with antibiotics and fluids significantly decrease morbidity and mortality, but it can also help prevent sepsis-associated cardiac arrest.

It’s clear that early intervention is crucial, but how is it done? We’ll break it down into two key steps: 1) knowing what signs to look for, and 2) implementing the right strategies to prioritize and support early detection.

Signs of sepsis

Early intervention starts with the basics: knowing what to look for. Signs of sepsis include4:

  • Temperature >38°C or <36°C
  • Heart rate >90 beats/min
  • Respiratory rate >20 breaths/min (or partial pressure of CO2 <32 mmHg)
  • Leukocyte count >12,000 cells/mm3 or <4000 cells/mm3

If a patient meets at least two of the above criteria, they have systemic inflammatory response syndrome (SIRS). To receive a diagnosis of sepsis, the patient must have SIRS plus an infection.

Knowing the signs of sepsis is important, but it’s only the first step. Without additional strategies in place to prioritize early detection, these signs can easily be missed or overlooked by the care team.

Strategies to prevent sepsis-associated cardiac arrest

Hospitals have a few options when it comes to preventing sepsis, septic shock, and sepsis-associated cardiac arrest.

Rapid response team

A rapid response team (RRT) is a team of clinicians trained to respond promptly to a patient showing signs of deterioration, such as the ones discussed in the previous section. RRTs bring critical care to the patient’s bedside to prevent transfer to a higher level of care, cardiac arrest, or death.5

One of the reasons RRTs can be an effective solution is because the signs of sepsis may appear subtle at first. For example, a higher temperature and slightly elevated heart and respiratory rate may not be enough to prompt a typical healthcare provider to consider a potential sepsis response. But for a specialized RRT using an algorithm to identify SIRS, it is possible to diagnose a patient in the early stages of sepsis if a source of infection is found.

Electronic assessment and monitoring

For hospitals that don’t have the resources for a specialized RRT focused on SIRS and sepsis treatment, electronic monitoring is another viable option. Electronic systems can capture patient vitals and automatically alert clinicians to a potential sepsis diagnosis when multiple SIRS signs are present. Importantly, this kind of digital documentation and alerting can also reduce error associated with calculating a SIRS score on paper.6

RRT plus electronic monitoring

Hospitals aren’t limited to using only one of the strategies discussed above if they have the resources for both. In fact, combining an RRT with electronic monitoring is a best-of-both-worlds scenario, melding the coordinated, systematic response of an RRT with the automatic monitoring and risk predictor informatics of electronic systems. This approach can support improved mortality from sepsis, prevent deterioration to shock and sepsis-associated cardiac arrest, and save patients from needing a longer hospital stay with more invasive interventions.6

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From identifying deteriorating patients to responding to a Code Blue, documentation is a critical component of high-quality cardiac arrest care.

You’ve already learned how electronic documentation and alerting can support early detection of sepsis. Next, read our article on the benefits of electronic Code Blue documentation to learn why paper-based methods hamper an optimal code response, and how CoDirectorTM resuscitation software from Nuvara® can help.

References

  1. Dooley, K., Guzik, W., Rooker, G., et. al.. (2022). Improving hospital sepsis care using PAs and NPs on a rapid response team. JAAPA, 35(10), 43–45. https://doi.org/10.1097/01.jaa.0000873808.41684.d3
  2. Morgan, R.W., Fitzgerald, J.C., Weiss, S.L., et. (2017). Sepsis-associated in-hospital cardiac arrest: epidemiology, pathophysiology, and potential therapies. J Crit Care, 40, 128-135. https://doi.org/10.1016/j.jcrc.2017.03.023
  3. Makic, M., & Bridges, E. (2018). Ce: Managing sepsis and septic shock: Current guidelines and definitions. AJN, American Journal of Nursing, 118(2), 34–39. https://doi.org/10.1097/01.naj.0000530223.33211.f5
  4. Gultepe, E., Green, J. P., Nguyen, H., et. al. (2014). From vital signs to clinical outcomes for patients with sepsis: A machine learning basis for a clinical decision support system. Journal of the American Medical Informatics Association, 21(2), 315–325. https://doi.org/10.1136/amiajnl-2013-001815
  5. Lyons, P. G., Edelson, D. P., & Churpek, M. M. (2018). Rapid response systems. Resuscitation, 128, 191–197. https://doi.org/10.1016/j.resuscitation.2018.05.013
  6. Joshi, M., Ashrafian, H., Arora, S., et. al. (2019). Digital alerting and outcomes in patients with sepsis: Systematic review and meta-analysis. Journal of Medical Internet Research, 21(12), e15166. https://doi.org/10.2196/15166
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