Harnessing Home Care in Early Sepsis Recognition

September 10, 2015 by CDC's Safe Healthcare Blog

Al Cardillo, Executive Vice President, Home Care Association of New York State

Guest Author: Al Cardillo
Executive Vice President
Home Care Association (HCA) of New York State

Early recognition of potential sepsis symptoms, rapid referral for confirmatory diagnosis, and swift intervention are imperative to protect patients. Health system leaders and practitioners need to put protocols and practices in place to advance early recognition and intervention to save lives. That is why our State Home Care Association is currently working to bring early recognition and intervention to the pre-hospital, community-based level, moving the horizon as far toward mitigation and prevention as possible.

On the hospital side, critical efforts are under way to promote early sepsis recognition and intervention in the acute setting. New York has adopted the nation’s first regulations requiring hospital protocols for treating patients with severe sepsis and septic shock, and the state hospital association is leading a targeted education and training system to assist hospitals in this effort.

However, at-risk patients most often enter the hospital care system through emergency rooms, arriving with unrecognized symptoms and unaware of the actual or looming severity of their condition. Not only do they arrive to the ER with symptoms which they’re not aware are potentially deadly, but this crisis is compounded by their decision to go to the ER almost too late. Consequently, by the time these patients reach the ER, they may already be on a course toward severe morbidity and possible death. The examples are daily and tragic, and the statistics are staggering.

Prompted by discussions with Sepsis Alliance, the Home Care Association of New York State (HCA) has undertaken a deep dive into the sepsis problem and the possible key role that home health professionals and agencies could play in prevention and management. We believe this to be a first-of-a kind, systematic, effort in the home care sector.

HCA has developed a robust sepsis action plan for home care. This multi-tiered action plan by the HCA Quality Committee thus far contains the following components:

Development of a first-of-a-kind sepsis screening tool for home care – currently drafted and in beta test;
Development of a clinical protocol to guide practitioner response;
Education and training of home care providers for systematic incorporation of the tool and protocol;
Collaboration with hospitals, physicians and other critical partners for coordinated sepsis response.

It is our hope that our model of harnessing New York’s home care system in sepsis prevention will be a critical contributor toward combating this serious and tragic health care problem. Moreover, we hope it can serve as a national model for other states to help save lives and reduce health costs.

Acknowledgements
I wish to acknowledge the contributions of the following individuals and organizations to our sepsis efforts: The HCA Quality Committee; Amy Bowerman, RN, Director of Quality Improvement, Mohawk Valley Health System; Thomas Heymann, Executive Director, Sepsis Alliance; Steven Simpson, MD, Professor of Medicine, Medical Director, University of Kansas and Sepsis Alliance Board; Juliann Corey, RN, Harvard/Beth Israel Deaconess Medical Center sepsis program; Sara Butterfield, RN, Senior Director of Health Care Quality Improvement, IPRO; Martin Doerfler, MD, Senior Vice President of Clinical Strategy and Development, North Shore-LIJ Health System; officials of the New York State Department of Health

September 10, 2015 by CDC's Safe Healthcare Blog