EHRs reveal that many sepsis deaths may not be preventable

Despite being one of the most frequent causes of hospital mortality, sepsis remains a complex syndrome that generally cannot be prevented through better care.

That’s the assessment of researchers at Brigham and Women's Hospital who reviewed electronic health records for patients admitted across six acute-care hospitals who died in a hospital or were discharged to end-of-life hospice.

Investigators conducted a retrospective cohort study that leveraged EHR data from 568 patients admitted to three academic medical centers and three community hospitals from January 2014 to December 2015.

What they found was that sepsis was present in 300 hospitalizations (52.8 percent) and directly caused death in 198 cases (34.9 percent). However, researchers concluded that most underlying causes of death were related to severe chronic comorbidities, and only 3.7 percent of sepsis-associated deaths were either definitely or moderately preventable.

“Although the burden of sepsis-associated mortality is high, our study indicates that most of these deaths may not be preventable through better hospital-based care,” according to the results published in JAMA Network Open. “Our findings are notable in light of many sepsis quality improvement initiatives that reported substantial decreases in mortality rates after implementation of sepsis care improvement initiatives.^”

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While other studies imply that many sepsis-associated deaths are preventable, the authors contend that a “possible explanation for this discrepancy is that improving sepsis care has already been a focus for the hospitals in our study.” In addition, they make the case that “analyses of performance improvement initiatives may overestimate their effect on mortality because sepsis quality improvement initiatives place a strong emphasis on improving recognition of sepsis in addition to improving sepsis care.”

“The point of this study is not to diminish the importance of sepsis quality-improvement issues in hospitals—even one preventable death is too much,” says lead author Chanu Rhee, MD, who is a critical care physician at Brigham and Women's Hospital.

"In addition, since we only reviewed medical records for patients who died, our study doesn't highlight all the other patients with sepsis for whom timely recognition and care in the hospital actually did prevent death,” adds Rhee. “One of the takeaways, however, is that further innovation in the prevention of underlying conditions might be necessary before we can see a really large reduction in sepsis mortality."