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Sepsis Medical Emergency:What Legislative Offices Need to Know
for their Constituents & Community
A Presentation byStop Sepsis At Home NY
November 19, 2019
Program FacultyFrom "Stop Sepsis At Home NY” Initiative
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Al Cardillo, LMSWPresident & CEOHome Care Associationof New York StateNational Sepsis AllianceAdvisory Board Member
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Sara Butterfield RNSenior Director for Quality ImprovementIPRO, and Project DirectorIPRO/US CMS Innovation Project inSepsis Early Recognition & InterventionHCA Sepsis Team
Amy Bowerman RN, BSN Executive DirectorSenior Network HealthDirector of Quality Improvement& Privacy OfficerMohawk Valley Health System Home Care Services
HCA Board of Directors
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Jillian Thibault, BSHCA Sepsis Team Consumer Partner
Special Remarks byHon. Greg Olsen
Director, NYS Office for AgingHCA Sepsis Steering Committee
Session Overview
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• Good morning, and welcome.
• Thank you participating this informational seminar on sepsis. Your time, interest and support in this area is so appreciated and crucial!
• Given the roles that you and the Legislature play in the governance of the state, in the design and operation of the health care system and, most of all, in the lives of the constituents and communities that you represent, you can have a truly profound impact on this medical emergency.
• We hope today’s presentation will be an invaluable resource for you and your constituents.
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Special Thanks ToLegislative Cosponsors
Session Overview
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Today’s presentation will cover:
• An introduction to sepsis as a medical emergency.
• Critical sepsis facts, and what you need to know about sepsis for your constituents, communities, health system and state policy.
• New York sepsis initiatives.
• HCA’s Stop Sepsis At Home NY program, a national first‐of‐a‐kind home and community health sepsis screening and intervention initiative.
• Next steps and how you can help!
• Critical sepsis resources for you and your constituents.
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In New York State and across the country, the many lives fundamentally
affected by sepsis inspire this preventive initiative.
Dedication of Purpose
What Do You Know About Sepsis in Your Community?
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Sepsis ‐ rare? No – a major, prolific public health problem and medical emergency!
• Turn and look at your colleagues at your left and right: 1 in 3 individuals will develop sepsis sometime in their lifetime.
• Sepsis takes 6 – 7 times the number of lives each year compared to the opioid tragedy. Sepsis takes a life every 2 minutes, and over 80% of deaths are potentially preventable.
• Severe sepsis and septic shock affect approximately 50,000 New Yorkers each year.
• Sepsis affects people of all ages, backgrounds, conditions.
• More people die from sepsis in hospitals than any other condition; but 80‐90% of sepsis originates in community.
Has anyone here had or known someone having sepsis?
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We mourn the loss of Senator Jose Peralta
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What Do You Know About Sepsis in Your Community?
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• Many (50% of the population) are not familiar with the word “sepsis,” and (the vast majority) confuse or cannot identify its signs.
• Sepsis needs to be as commonly discussed and understood as heart disease or stroke. Sepsis must be treated as quickly and urgently as possible.
• YOU can help, and are doing so with your participation here today.
Helping in YOUR Community
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You can help save lives!
Help your communities!
Save catastrophic costs!
• Knowing sepsis, increasing awareness in your communities, supporting sepsis survivors and families, supporting your health care providers (hospitals, physicians, home health care, emergency medical services, clinics), supporting legislative and budget programing, are just some of the ways.
Helping in YOUR Community
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Some very basic and readily impactful things you can do in your legislative work to help with sepsis your community:
1. Know the condition and spread the word about it in your conversations, newsletters, meetings, outreach to your constituents and the media; participate in and support organized sepsis events; sponsor education sessions with your local libraries, home care agencies, hospitals, schools, camps, offices for aging, physicians; support these providers in sepsis intervention; and more.
2. Know and help make your constituents – especially sepsis survivors and their family and caregivers ‐ aware of critical sepsis resources (contacts are provided for you at the end of this presentation); obtain, co‐brand and make available/distribute community information.
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So what is sepsis?What do you know?
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Washington Post, Health & Science, August 2016
“While the deaths … of actress Patty Duke and boxing legend Muhammad Ali (and
Muppets creator Jim Henson in 1990) have brought attention to sepsis, fewer than half of Americans know what the condition is, according to Thomas Heymann, Executive
Director of the Sepsis Alliance.”
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A Medical Emergency !https://rorystauntonfoundationforsepsis.org/sepsis‐need‐know‐save‐life‐2/
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• Sepsis is the body’s overwhelming and life‐threatening response to infection. It can lead to tissue damage, organ failure, and death.
• Sepsis can happen quickly and be confused with other conditions early on.
• Sepsis is a medical emergency. Sepsis is deadly when it’s not quickly recognized and treated.
• Time matters. When sepsis is quickly recognized and treated, lives are saved.
• Health care providers are the critical link to preventing, recognizing, and treating sepsis.
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Sepsis Alliance Campaign:It’s About Time
Know the signs and symptoms!
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Sepsis affects the healthy, the ill, the strong, the weak, the young, the old, grandparents, and grandchildren. Among all, older adults, the chronically ill , immunocompromised and those with opportune exposure to infection are the highest risk categories.
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From National Sepsis Alliance:
• Sepsis is a very serious illness for anyone at any age, and can be particularly devastating for seniors.
• According to a study published in 2010, older severe sepsis survivors were more than three times more likely to see a drop in cognitive (mental) abilities that can make it impossible for them to return to their previous living arrangements.
• This often results in admission into a chronic healthcare facility. As well, the risk of dying from severe sepsis or septic shock rises as you get older.
Why is Sepsis So Serious for Older People
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Perspective on SepsisRelated to Older New Yorkers
Hon. Greg Olson, DirectorNYS Office For Aging
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Sepsis Treatment and SurvivalFrom National Sepsis Alliance:
• Sepsis needs to be suspected and recognized as quickly as possible. It must be treated fast as every hour that sepsis is not treated increases the risk of death.
• Treatment is with IV fluids and antibiotics. Other medications, such as those to raise blood pressure may be needed.
• Sepsis can move very rapidly with devastating consequences.
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Sepsis Treatment and Survival
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PreventionFrom National Sepsis Alliance:
• The key to preventing sepsis is to prevent an infection from occurring in the first place. If an infection does set in, it must be treated as quickly and effectively as possible.
• Many illnesses can be and are prevented through regular vaccinations, such as for the flu or pneumonia.
• The risk of getting an infection also drops with proper hand washing.
• Infections can also be reduced by proper care of all wounds, even the smallest scrape or cut. A thorough cleaning with soap and water will help remove any bacteria at the wound opening.
• Any infection should be taken seriously.
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Consumer Perspective
Jillian Thibault
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Critical Sepsis Facts
Sepsis in the Health Care System and Community
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Washington Post, Health & Science, August 2016
“The Centers for Disease Control and Prevention has declared sepsis a medical emergency, reporting … that about 72
percent of patients with this fast‐moving and deadly illness have recently been seen
by doctors and nurses, representing missed opportunities to catch it early or
prevent it.”
Compelling Stats
• 1.7 million cases each year in the U.S.
• 270,000 deaths each year – more than breast cancer, prostate cancer and AIDS – combined.
• Every 2 minutes someone in the US dies of sepsis.
• Takes more children than cancer – 18 kids each day.
• #1 cost of hospitalization ‐ $27B/yr.
• Every 20 seconds someone is hospitalized with sepsis.
• #1 cause of death in U.S. hospitals.
• #1 driver of readmission to a hospital (30 days).
Critical Sepsis Facts and Relevance to Home Health and Health Reform
(Sepsis Alliance)
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Critical Sepsis Facts and Relevance to Home Health and Health Reform
(Agency for Healthcare Research & Quality)
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• #1 Medicaid expense for potentially avoidable hospitalizations for general MA population in NYS hospitals (excluding schizophrenia in the MH population), and #2 in Medicaid hospital expense nationally (after Liveborns).
• 1 in 4 hospital patients treated for sepsis is readmitted in the first 30 days after discharge.
• Sepsis is nearly double the readmission rate of the top CMS‐clocked readmission cause “heart failure” that is subject to hospital penalty (study in January 2017 Journal of American Medical Association).
Critical Sepsis Facts and Relevance to Home Health and Health Reform
(NYS DOH/KPMG VBP project, Sepsis Alliance, JAMA, AHRQ)
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• Up to 50% of sepsis survivors suffer from post‐sepsis syndrome, with consequences for ongoing primary and community care.
• US DHHS estimates that sepsis results in an average of 38 amputations each day.
• Commonly misunderstood as a “hospital problem,” whereas 80% ‐ 90% of sepsis cases originate in home and community.
• Time critical; mortality increases 8% every hour that treatment is delayed.
• Early identification and treatment are the key to improved outcomes and reduced costs.
• Big opportunity lies in public awareness and primary providers’ education and training.
Critical Sepsis Facts and Relevance to Home Health and Health Reform
(Sepsis Alliance, DHHS)
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• Among highest risk populations are:
The elderly
The chronically ill
Persons with disabilities
The very young; espmedically fragile children
Individuals with compromised immune systems
Individuals with recurrent UTI and pneumonia
Others (e.g., post surgical, maternal and neonatal care)
• These high risk groups are populations especially vulnerable to sepsis that home care treats or can be within its reach.
Critical Sepsis Facts and Relevance to Home Health and Health Reform
(Sepsis Alliance, DHHS)
NYS Medicare FFS Admissions with a Diagnosis of Sepsis While Receiving Home Health Care – July 2016 ‐ June 2017
Prepared by AQIN/QIO IPRO
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Days Of Home Health Care Prior to Admission*:Less Than Seven Days 1,635 19.2%Eight To Thirty Days 3,014 35.4%More Than Thirty Days 3,870 45.4%
Opportunity to positively impact Home Health population through earlier recognition of sepsis
Hospital Admissions: Patients with one or more admissions: 7,353 Total number of admissions: 8,519
Hospital Utilization: Average Length of Stay: 11.4 days Total Days of Care: 97,027
Hospital Medicare FFS Expenditure: Average Expenditure Per Case: $23,050 Estimated Total Expenditure: $196 Million
Highest Mortality Rate Occurs within first 5 days ofhospital Stay
Source: CMS Medicare FFS Paid Claims Data 33
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Sepsis AllianceSepsis 911 Video
https://vimeo.com/232541328
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Innovation inSepsis Screening and Intervention
in Hospitals_________
“Rory’s Regulation’s”A National‐First in
Hospital Sepsis Protocols
In tribute to Rory Staunton & Rory’s Story
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NYS ”Rory’s Regulations”
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Sepsis Educational Programing_________
“Rory’s Law”
Sepsis Education Programming
• S.4971‐A and A.6053‐A, Chapter 347 of 2017.
• Establishes a sepsis awareness, prevention and education program within the NYS Education Dept.
• Requires the NYS Commissioner of Education to collaborate with the NYS Commissioner of Health, organizations that promote sepsis awareness, as well as other interested parties, to develop a sepsis awareness, prevention and education program.
• Requires that sepsis be included in school educational programming, in information to parents on sepsis, and included as part of the existing infection control education/training required of health clinicians under the NYS Education Law. 39
“Rory’s Law”
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Innovation inSepsis Screening and Intervention
in the Community
Introduction to HCA‐NYS First‐of‐a‐KindHome Care Sepsis Tool & Initiative
HCA Home Care Sepsis Initiative
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Development of the Home care Sepsis Tool and Initiative• HCA, core sepsis partners and state/national sepsis clinical
experts developed a national‐first, screening tool and protocol for sepsis for home and community health levels.
• The tool was officially launched March 31, 2017. Home care providers trained and authorized to use the tool currently cover 55 of the state’s 62 counties. (see next slide)
• The tool is specifically designed for use by home care clinicians, but can apply in many settings, including ambulatory care, group homes, hospice, nursing homes, more, and is synchronized to sepsis criteria and protocols applied in hospitals (“Rory’s Regulations”)
• As we continue promoting this tool for statewide adoption across NYS, this tool is “the model” being promoted in other states and at national levels.
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(Work‐in‐Progress as of June 1, 2018)
NYS Counties with HCA Sepsis Tool User(s)
HCA Home Care Sepsis Initiative
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• Orientation and training on the tool and on sepsis substantively are prerequisites for provider use of the tool.
• Authorized use of the tool is granted to providers via user agreement ([email protected]) that confirms the prerequisites and strict adherence to use standards.
• HCA has created the dedicated “Stop Sepsis At Home NY” website resource: http://stopsepsisathomeny.org/
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Presentation of the HCA Sepsis Screening Tool
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HCA Sepsis Screening Tool
Overview of HCA Home Care Sepsis Initiative
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Sepsis Screen Tool – Question Section
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Sepsis Screen Tool – Follow‐up Section
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Sepsis Screen Tool – Intervention Section
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Patient Education “Zone Tool”
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Guidance for Agency Adoption and Use • A toolkit has been developed to assist all agencies in staff
training and education on sepsis and the sepsis tool.
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Preliminary Data and Program Results to Date
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• Creation of primary pre‐hospital layer for sepsis screening, prevention, early intervention. Near statewide geographic implementation accomplished.
Several hundred thousand screens for risk, prevention, early treatment completed to date, and ongoing as part of system.
Total caseload size for screening by agencies trained and using, or readying for use, exceeds 330,000 to date.
Significant new sepsis trained health workforce statewide.
• Agencies achieving earlier sepsis identification and timely Tx. One agency example: Over 218 cases meeting sepsis criteria
identified early by the agency, leading to intervention at home by the collaborating physician and the home care agency. (Another agency reports 78 such cases of in‐home identification and Tx.)
Same agency also identified over 253 cases meeting severe sepsis criteria, leading to corresponding intervention by the physician, agency clinician, and EMS/hospital partners.
Some Preliminary Results to Date from HCA
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• Fiscal Considerations/Modeling CY 2018 average Medicare Fee–for‐Service amount billed by NYS
hospitals for sepsis related inpatient care = $110,913.21 (source: IPRO, Medicare claims)
CY 2018 average Medicare FFS amount paid by Medicare to NYS hospitals for sepsis related inpatient care = $22,827.07 (source: IPRO, Medicare claims)
By illustration, full hospital avoidance of the prior slide example of 218 cases identified by the HC agency would = potential cost avoidance of $24,179,079 Medicare average billed, or $4,976,301 paid; additional potential savings from sepsis mitigation of the 258 severe cases identified in‐home via the sepsis tool.
• See further fiscal example, next slide, based on illustration using hospital mean costs related to sepsis care in NYS, and conservative assumptions of partial hospital avoidance.
Results to Date
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• Agencies report additional cost avoidance and improved outcome potential through overall greater awareness and screening for infection risk via tool, increased preventive education with patients/families, increased identification of associated high‐risk conditions (e.g., UTI, fever), focus on sepsis readmission avoidance, LTC avoidance/mitigation.
• Model being applied to other settings and populations (e.g., group homes for intellectually and developmentally disabled adults, hospice, assisted living, etc.)
• Model being replicated in other states by associations, health systems, agencies, organizations (incl. EMRs).
• Sepsis Alliance national education and level‐I training video documentary produced on tool; being finalized and soon promoted to all applicable providers in US.
Results to Date
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Next Steps
• Continued provider training and work across sectors to employ the sepsis tool.
• Continued promotion of cross‐sector coordination of clinical partners; develop best practice guidelines across sectors. Goal = coordinated continuum‐response to sepsis.
• Data collection, research and analysis.
• Intensify public education and outreach.
• Senator Rivera/Assemblyman McDonald’s legislation S.1817/A.3839 that has passed both Houses and awaits delivery to Governor. (See next slide)
• Development of HCA tool version for sepsis in children.
• Promote models of integrated care, coverage and support for individuals post‐sepsis . 60
Some Next Steps
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HCA Sepsis Collaboration LegislationPassed both Houses of NYS 2019 – Awaiting Gov’s Signature
Features:
1. Support for staff training.
2. Integration with EHR.
3. Health Information Exchange with critical partners (home health, physician, EMS, hospital).
4. Sepsis collaboratives (home care‐hospital‐physician) for sepsis prevention/mitigation/ timely response, and for transition and interdisciplinary care for sepsis survivors.
5. Community outreach and public education.
New Sepsis Alliance Video Life After Sepsis.
https://www.sepsis.org/life‐after‐sepsis/
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Development Support Services
for Sepsis Survivors
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Sepsis Partner and LeaderInformation and Education
Resources
Resources• Home Care Association of NYS, Inc., and Stop Sepsis At Home NY
website: http://stopsepsisathomeny.org/
• Centers for Disease Control & Prevention http://www.cdc.gov/sepsis/
• Sepsis Alliance ‐ http://www.sepsisalliance.org/
• The Rory Staunton Foundation for Sepsis Prevention https://rorystauntonfoundationforsepsis.org/
• NYS Department of Health ‐ https://www.health.ny.gov/
• AQIN / IPRO ‐ http://www.stopsepsisnow.org
• Centers for Medicare & Medicaid Services http://www.medicare.gov
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RoryStauntonFoundationForSepsis.org
The tragic loss of Rory Staunton to sepsis in 2012 spirited the establishment of the Rory Staunton Foundation for Sepsis Prevention by Rory’s parents, Ciaran and Orlaith Staunton, as well as the first in the nation (NYS) hospital protocols for sepsis in 2013 “Rory’s Regulations”. The Foundation’s work also led to the signing of “Rory’s Law” in NYS, a landmark law that will provide for sepsis education in the schools and in state law requirements for health provider education/training in infection control, as well as other proactive sepsis initiatives in others states.
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Rory Staunton Foundation for Sepsis Prevention
RoryStauntonFoundationForSepsis.org
The Rory Staunton Foundation website contains assistive background on sepsis developments and educational resources. Below are drop down menus and other examples from the site.
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Sepsis Alliance
68Sepsis.org
Sepsis Alliance Webpage and Resources
Contacts
• Al Cardillo, [email protected]
• Amy Bowerman, [email protected]
• Sara Butterfield, Sara.Butterfield@area‐I.hcqis.org
• Thomas Heymann, [email protected]
• Orlaith Staunton, [email protected]
