The value of rapid sepsis treatment: New research

A new study published in The New England Journal of Medicine by a team that includes IHPI members looks at the controversy surrounding how quickly sepsis must be treated.

Using data from 185 hospitals on patients with sepsis and septic shock, researchers found that faster administration of care was linked with lower mortality.

The study team included Michigan Medicine researchers and University of Michigan Institute for Healthcare Policy and Innovation members Hallie Prescott, M.D., assistant professor of internal medicine, and Theodore Iwashyna, M.D., Ph.D., associate professor of internal medicine.

Both time to antibiotics and time to “three-hour bundle” completion were associated with lower risk-adjusted mortality. For every additional hour of delay in these treatments, odds of mortality increased by 4 percent.

“This is the largest study to date looking at time to antibiotics in sepsis treatment,” Prescott says. “It was made possible as a result of patient-level data collected in New York as part of new statewide sepsis regulations, known as Rory’s Regulations.”

These regulations were put in place after 12-year-old Rory Staunton died in 2012 of unrecognized sepsis. The regulations require hospitals to develop and implement protocols for sepsis recognition and treatment, as well as to report data on all patients recognized to have sepsis starting in 2014.

The core elements in the sepsis protocols were the delivery of antibiotics, measurement of lactate and collection of blood cultures within three hours of patients arriving. These three treatments are known as the three-hour bundle. The study tested whether earlier treatment was associated with better outcomes among patients who presented to an emergency department and were treated within 12 hours.

“We found that we can reduce avoidable deaths by treating patients with sepsis and septic shock more quickly upon their arrival to the emergency department,” Prescott says. “These findings argue that hospitals and health care systems should invest in infrastructure to get antibiotics to patients as soon as possible — just as we get patients with heart attacks to the catheterization lab as soon as possible. With each hour of delay, patients have a greater risk of death.”