PROVIDENCE – The rate at which Rhode Island hospitals properly treat sepsis, a life-threatening reaction to infection that kills more than 200,000 people yearly across the nation, is nearly nine percentage points lower than the national average, and is fourth-worst in the United States, according to data released by the Centers for Medicaid and Medicare Services.
Ocean State hospitals on average properly treat sepsis 40 percent of the time, according to the CMS statistics, versus the national average of 49 percent. Rhode Island ranked above Puerto Rico, 11 percent; District of Columbia, 35 percent; and Delaware, 36 percent.
Local hospital officials contacted for this story said the CMS ratings don’t accurately reflect their readiness to treat sepsis cases because data used is several months behind their continuous efforts to improve treatment. They also warned against comparing hospitals within the state without taking the volume of patients cared for into consideration.
CMS has been asking hospitals to report on the treatment of sepsis for years now, said Sean Benson, vice president of specialized surveillance at Wolters Kluwer Health., a consultancy with a health care practice. Benson said the measure is focused on when sepsis is diagnosed and then how quickly after diagnosis certain treatments are performed. The treatments include ordering a blood test for lactate, a chemical produced by cells for fuel during stress, drawing blood cultures, giving antibiotics, fluid resuscitation and using vasopressors, he said.
This is the first year CMS has posted scores based on the collected information to its website, but the agency also took the unusual step of allowing the hospitals to choose their own populations to report on sepsis care, which could have resulted in better scores. That indicates many of the nation’s hospitals have a lot of work ahead in preparing to treat sepsis and identifying their weaknesses, Benson said. He added that the scoring based on voluntary reporting is likely CMS’ first step toward incorporating sepsis care performance rates into reimbursement rate calculation.
In Rhode Island, scores ranged from 16 percent at Westerly Hospital to 80 percent at South County Hospital, double the state average.
“We collect data on every sepsis patient that comes into the hospital and try to see what we missed or can do better,” said Bobbie Fay, director of critical care services. “We emphasize a team approach, with the emergency department, ICU, hospitalists, lab and our performance improvement department, sending out monthly updates and soliciting feedback among the sepsis team.”
She said that while every hospital strives to provide the best care possible, keeping up with frequent changes in the regulations is a challenge.
Lifespan’s Newport Hospital scored 44 percent, and The Miriam Hospital correctly treated sepsis 36 percent of the time, with Rhode Island Hospital scoring 21 percent. Care New England hospitals Kent Hospital, and Women & Infants Hospital each scored 35 percent. CharterCARE hospital Our Lady of Fatima performed the correct treatment 35 percent of the time, while its Roger Williams Medical Center followed correct procedure 76 percent of the time. Landmark Medical Center followed correct procedure 75 percent of the time.
Rhode Island Hospital’s score at 21 percent is based on data submitted eight months ago, said Dr. Mitchell Levy, chief of Rhode Island Hospital’s division of pulmonary, critical care and sleep medicine, and medical director of the medical intensive care unit. Levy has led Rhode Island hospitals’ efforts in sepsis care.
In the last eight months, Levy said, the hospital has improved its response time to sepsis cases using computerized alerts, which has resulted in the hospital reaching a 20 percent mortality rate for sepsis cases, ahead of the national average, 24.3 percent according to a NCBI report. He said the CMS assessment performed today would put Rhode Island Hospital at a 42 percent score, better than three-quarters of hospitals in the country.
Levy pointed to Rhode Island Hospital’s long-standing involvement with the Surviving Sepsis Campaign, underlining the importance of sepsis care to hospital leadership. Hospitals involved in the campaign nation-wide, including Rhode Island Hospital, have contributed to the measures CMS is using in its assessment, he said.
Levy also noted that Rhode Island Hospital, the largest in the state, isn’t fairly compared to other, smaller hospitals because smaller populations of patients are easier to treat.
“I don’t mean to say that Roger Williams isn’t doing a good job,” Levy said. “You have to go to Boston to find similar hospitals [to Rhode Island Hospital’s size].”
“We are pleased to see Roger Williams Medical Center rank in the top 10 percent in the nation for sepsis care, placing us as a national leader in this area,” CharterCARE said in a statement. “Across the CharterCARE system, we have worked to develop standardized sepsis care practices and are anticipating Fatima Hospital’s scores will reflect that in future reports from CMS. It is well worth noting that the CMS Sepsis-1 quality measure data used is dated and does not accurately reflect where Fatima stands today in relation to meeting the Sepsis-1 measure.”
Robin Neale, system director of clinical effectiveness for Care New England, had this reaction to the CMS data: “Ensuring the safety of our patients is our highest priority across Care New England. We take these newly-published data very seriously, understanding that the measures for the care of patients with sepsis are complicated and rigorous, as evidenced by low national average performance.
“CNE has taken steps toward improvement, including electronic alerts that notify the provider when certain vital signs and laboratory tests may indicate sepsis. In addition, with a high volume of sepsis patients, Kent has initiated a sepsis response team in the emergency room. Once sepsis is identified, an expert team trained in sepsis management responds to the bedside to initiate treatment,” Neale said. “Early data show this results in antibiotics being ordered and administered earlier, and IV fluids being given using weight-based dosing in a timely manner. Both Kent and Women & Infants have established Sepsis Task Force teams to continue to improve on this work. We are confident that our efforts in documentation and further standardization in care will result in improved outcomes in the area of sepsis.”
Massachusetts’ average percentile score matched the national average, 49 percent, with a number of Bristol County institutions scoring higher than the national average. High scores ranged between 66 and 78 percent, with only one hospital in the county, Southcoast Hospital, marked below the national average at 42 percent.
“Southcoast Health has worked hard to improve both the quality of sepsis care and reporting on that care, which has resulted in a rate of at least 55 percent in each of the last six months. The sepsis information released by CMS Hospital Compare includes data from January to September 2017 and does not reflect the dramatic improvements made since our quality initiative started in June 2017,” said Dr. Dani Hackner, Southcoast Health physician-in-chief for medicine.
Hackner said the company has worked with medical staff to redesign processes, educate staff and update its electronic health record system, Epic.
“Southcoast Health is now moving steadily toward standardizing care in the later stages of sepsis to further improve our outcomes and documentation,” Hackner said.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
Correction: A previous version of this story omitted South County Hospital’s score for following correct sepsis treatment procedure.
