NY plans new hospital rules for treating sepsis

Wednesday January 30, 2013

ALBANY, N.Y. (AP) -- New York health officials on Tuesday proposed requirements that hospitals set new protocols to screen and treat sepsis, an often deadly condition that can follow infections, including calling for antibiotics within an hour of diagnosis.

They also proposed a separate requirement that hospitals clearly communicate test results to parents before children are discharged. The measures followed the death of a 12-year-old boy from sepsis last year after he was discharged from a Manhattan emergency room.

State Health Commissioner Dr. Nirav Shah said the regulations, which are expected to take effect in May after a public comment period, could prevent 5,000 to 8,000 deaths a year. "New York will become the first state in the nation to require our hospitals to adopt best practices for the early identification and treatment of sepsis," he said.

Afflicting more than 750,000 Americans annually and killing more than 200,000, sepsis is the leading cause of death in hospitals, killing more people annually than AIDS, prostate cancer and breast cancer, Shah said. The inflammation from a blood inflection can lead to a progressive shutdown of the body’s organs.

It accounts for an estimated $17 billion in U.S. health care costs annually, Shah said. While related hospital mortality rates range from 15 percent to 37 percent, higher where staff is unprepared or untrained, pilot programs have shown the effectiveness of prompt treatment with antibiotics and fluids.

According to the Health Department, New York’s severe sepsis cases increased from 26,001 in 2005 to 43,608 in 2011, up 68 percent, while total cases rose from 71,049 to 100,073, up 41 percent. Rates are expected to keep rising with the growing use of invasive medical procedures, immune-suppressing therapies and more elderly and high-risk patients.

The department said it will publish time frame guidance for hospitals, though at a stakeholders’ conference last year, "it emerged that the current best practice is to pursue administration of antibiotics and fluid resuscitation within one hour of a diagnosis of sepsis, with full implementation of sepsis protocols within 3 hours for severe sepsis and six hours for septic shock." That could change with advances in research and practice, the proposal said.

Ciaran Staunton, whose 12-year-old son, Rory, died last year from sepsis, four days after he fell while playing basketball and cut his arm, said he had been seen by both his pediatrician and at the hospital emergency room, where he was discharged without a key blood test for infection. Staunton and his wife, Orlaith, said they are advocating for other states and the federal government to follow New York’s approach.

"We’re saying: ‘Look for sepsis. Here are the symptoms,"’ Staunton said. For Rory, initially misdiagnosed with a stomach flu, the symptoms included an abnormally high temperature, mottled skin and a sore leg. "We can’t bring him back. We can stop the torture of other parents," he said.

NYU Langone Medical Center said later that its emergency doctors and nurses would be "immediately notified" of certain lab results suggesting serious infection, like those that arose for Rory three hours after he had left the emergency room. The hospital also told The New York Times that it had developed a new checklist to ensure medical staff reviewed all critical lab results and vital signs before a patient leaves.

The state’s second proposed regulation said no hospital discharge should occur "while critical value tests are pending so as to assure appropriate care is provided." It would require hospitals to implement written policies to review and clearly communicate test results to emergency room patients and to parents or guardians of those who are underage.





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