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Preventing Sepsis with Cognitive Machines

  • JVION Health

Sepsis confounds care providers because we should be able to avoid it. Nonetheless, it is the most preventable cause of death worldwide.

Sepsis is especially cruel because our own bodies cause it through the natural response to infection, working so hard to battle that they break down tissues and organs. And it is stealth, often not diagnosed until it is too late.

Sepsis often starts while patients are in care settings:

  • Most sepsis cases (58 percent) originate in healthcare-associated settings, with 18 percent hospital onset and 42 percent community associated
  • Half of community acquired sepsis cases involve patients with chronic conditions such as diabetes, cancer, or congestive heart failure that lead to frequent encounters with healthcare providers
  • Sepsis is most commonly associated with acute care hospitalizations and nursing home stays greater than two days in the preceding 30 days

https://www.cdc.gov/mmwr/index.html

The effects and costs of sepsis extend far beyond the initial incident. Survivors of sepsis utilize greater healthcare resources: 

  • Profound immune suppression resulting in increased morbidity
  • Impaired quality of life
  • Substantial depressive symptoms among 28 percent of survivors

Sepsis also disproportionately affects older patients under care, with many contributors in place for an aging population:

  • Increased longevity for people with chronic diseases
  • Greater use of invasive procedures that introduce microorganisms into the body
  • Broader use of immunosuppressive drugs, chemotherapy, and transplantation
  • The spread of antibiotic-resistant organisms
  • Improved clinical awareness and diagnosis of sepsis

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.jsp

Sepsis takes a devastating toll on health, morbidity, and quality of life:

  • Sepsis causes 1.6 deaths in infants and children worldwide—more than any other cause
  • Severe septic patients spend twice as long in the hospitals as patients without severe sepsis (16.5 days versus 8.5 days) and more than twice as long in the ICU (10 days versus 4.6 days)
  • The mean average length of stay for a sepsis patient is nine days, about double the overall average
  • Mortality increases 8 percent for every hour that sepsis treatment is delayed
  • Risk of death after a sepsis episode persists up to five years after hospitalization
  • Mortality rates:
    • 21.2 percent index admission
    • 51.4 percent after one year
    • 74.2 percent at five years

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.jsp

Hospitals struggle to overcome the impact on outcomes, operations, and financial stability:

  • Adult sepsis cost hospitals $21,000 per patient in 2014
  • Accounted for $23.7 billion in healthcare expenditures in 2013
  • Sepsis results in 5.2 percent of the total aggregate cost for all hospitalizations in the United States
  • Pediatric sepsis costs an estimated $29,829 to $65,639 per case
  • According to the 2013 Nationwide Readmissions Database, which comprises 49 percent of U.S. inpatients, sepsis accounts for 12.2 percent of readmissions.
  • In 2013, $5.5 billion was spent on 400,000 Medicare beneficiaries hospitalized with sepsis
  • In 2011, $20.3 billion was spent on hospital care for sepsis—equal to $55,616,438 per day

https://www.ncbi.nlm.nih.gov/pubmed/26051981

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477829/pdf/nihms670565.pdf

https://blogs.cdc.gov/safehealthcare/the-cost-of-sepsis/

https://www.sciencedaily.com/releases/2017/01/170123151425.htm

There are also pressing regulatory considerations for providers related to sepsis. The Centers for Medicare & Medicaid Services (CMS) has adopted sepsis care bundles that include all patients with severe sepsis or septic shock discharged on or after October 1, 2015. 

  • The SEP-1 measure focuses on early diagnosis and rapid initiation of appropriate treatment.
  • There are a minimum of three components and a maximum of seven components for this measure. Providers must comply with all required components.
  • Adherence to core sepsis measures determines hospital reimbursement, so compliance is critical, especially for facilities with a high proportion of Medicare and Medicaid patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396984/

Promise for Improvement: The Cognitive Machine Helps Reduce Sepsis Occurrence

In hospitals and in modeling, the JVION Cognitive Clinical Success Machine has indicated a 10 percent reduction in the incidence of sepsis. Given the average cost estimate per adult inpatient sepsis case of approximately $20,000, a 10 percent reduction of approximately 750,000 reported cases per year would equate to a $1.58 billion in potential cost avoidance.