The story is too common – a person feels unwell and after a few days ends up going to their primary care provider or an urgent care center. They are evaluated, sent home, and several days later end up back in the office and evaluated again. This cycle continues until eventually the person’s health deteriorates to the point of crisis and they end up in the emergency department (ED). Once they arrive in the ED, they’re found to have sepsis and admitted. In many cases, they arrive profoundly hypotensive and are admitted to the intensive care unit with septic shock.

What went wrong? There’s a failure to recognize sepsis.

In 2011, the Sepsis Alliance named September as Sepsis Awareness Month (Sepsis Alliance, 2023). According to the Centers for Disease Control and Prevention (CDC), 1.7 million Americans develop sepsis annually of which 350,000 die or are discharged to hospice. Sepsis is a global issue; 11 million people worldwide die of sepsis each year with 65% of those being between 65 and 79 years of age and 89% older than 80 years (CDC). A recent study published in Critical Care Explorations looking at sepsis medical-legal claims in Canada, found that in admitted sepsis patients, 49% of patients had made multiple visits to primary care providers, walk-in clinics, or the ED 72 hours prior to admission (Neilson et al., 2023). 

Lack of sepsis awareness is a multifactor issue.

According to the literature, failure to recognize sepsis can be divided into three categories based on provider, team, and system factors.

1. Provider factors include lack of knowledge about sepsis, failure to manage and monitor the patient appropriately.
2. Team factors include communication breakdown across the care team which delays follow up with the patient and their family.
3. System factors tend to cluster around access to care and resources,  admission and transfer delays.

Regardless, lack of time to adequately assess and then follow up with the patient, lack of sepsis knowledge, and lack of access to care resources are consistently evident. These problems are not unique to sepsis; they’re a consistent issue across an ailing healthcare system.

Let’s change the trajectory of sepsis.

The healthcare system needs to invest in improving access to care and improving coordination of professionals and resources available to assess, treat, and follow up with patients. The multidisciplinary team needs continual education and training on sepsis recognition and management based on the latest evidence-based guidelines. The public needs further education on sepsis awareness and where to go for help if they can’t get into see their primary care provider. The CDC has recently issued Hospital Sepsis Program Core Elements to optimize sepsis identification, management, and education, as well as improve hospital leadership commitment and accountability.  

As healthcare professionals, we have the power to initiate change and alter the trajectory of sepsis and sepsis awareness. We need to continually update our knowledge and skills related to sepsis recognition and the guidelines for sepsis management. We need to teach our patients and their families to advocate for themselves. We need to improve everyone’s access to care so we can stop sepsis from claiming another life.

References:
Centers for Disease Control and Prevention (CDC). (2023, August 24). Hospital sepsis program core elements. https://www.cdc.gov/sepsis/core-elements.html

Centers for Disease Control and Prevention (CDC). (2022, August 9).  Sepsis technical resources & guidelines. https://www.cdc.gov/sepsis/clinicaltools/index.html

Neilson, H. K., Fortier, J. H., Finestone, P. J., Ogilby, C. M., Liu, R., Bridges, E. J., & Garber, G. E. (2023). Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims. Critical care explorations, 5(2), e0841. https://doi.org/10.1097/CCE.0000000000000841

Sepsis Alliance. (2023). Sepsis Awareness Month. https://www.sepsis.org/get-involved/sepsis-awareness-month/