New York’s sepsis protocols lower death rates, according to JAMA study

July 29, 2019
Medicare Web

New York’s statewide sepsis protocols appear to be working, according to a new study in the Journal of the American Medical Association (JAMA).

The protocols—known as Rory’s Regulations—became law in 2013, following the death of 12-year-old Rory Staunton from undiagnosed, untreated sepsis. The protocols mandate that all hospitals adopt evidence-based practices for the identification and treatment of sepsis, HealthLeaders Media reported.

University of Pittsburgh researchers examined more than a million sepsis admission records from New York and four control states (Florida, Maryland, Massachusetts, and New Jersey) in the years before and after Rory’s Regulations took effect. They found that sepsis mortality rates dropped 4.3% in New York and 2.9% in the control states, according to the JAMA report.

The researchers showed that New York’s sepsis death rate was 3.2% lower following the regulations than would have been expected, relative to the control states.

Lead author Jeremy Kahn, MD, says the study is the first to conclusively link improvements in sepsis outcomes with the implementation of holistic, evidence-based regulations. There are three things that make the regulations successful, Kahn told HealthLeaders Media:

  1. “All hospitals are mandated to implement protocols for evidence-based treatment and recognition, and more patients are getting these evidence-based therapies, specifically, early antibiotics and resuscitation.”
  2. “They’re also educating staff at all hospitals in New York state so that people are going to recognize and treat sepsis better.”
  3. “They’re just paying attention to it. Sepsis has not been on the public health radar for many years […] Just by turning our lens on sepsis, we’re able to think about it in new ways, recognize it earlier, and treat it more effectively.”

Thus far, Kahn said, two other states have implemented similar sepsis initiatives (Illinois and New Jersey), and 10-12 more are considering implementing them in the near future.

While the measures seem to be working in New York, Kahn advises against immediate and unqualified adoption just yet, according to HealthLeaders MediaFirst of all, researchers don’t know whether the measures would work well in other states or what makes them work well in New York. Plus, Kahn warned, there are a couple downsides to policy-based approaches to sepsis care, namely:

  1. Policy-based sepsis care can lead to overtreatment which in turn can lead to needlessly invasive procedures and unnecessary costs.
  2. Policy-based sepsis care is a heavy-handed approach and the measures need to be flexible in light of changing best practice advice.

With these risks in mind, Kahn advised that states proceed with caution and discuss the best possible options for the individual states’ needs.

“Get the right people to the table. One of the things that was most successful about the New York experience was that it wasn’t just the regulators developing and implementing the policy,” Kahn told HealthLeaders Media“The health systems, clinicians, and the patients’ advocates were all at the table in an exceptionally collaborative effort to develop and implement these policies.”

Editor’s note: To read HealthLeaders Media’s full interview with Kahn, click here. To read about the study from JAMA, click here. To read a recent Ask ACDIS column about sepsis treatment and documentation requirements, click here.