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Sepsis-NewYork to Be First State to Mandate Protocols 

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Sepsis-NewYork to Be First State to Mandate Protocols

Sepsis is one of the most difficult, sneaky killers, yet its threat is little known to the general public.
It begins when an infection, however mild, seeps into the bloodstream and triggers the body to produce an overwhelming, self-destructive immune response, potentially leading to organ failure.
New York would be the first state in the nation to mandate specific protocols to reduce death from sepsis under a plan introduced in Gov. Andrew Cuomo's State of the State presentation.
Sepsis is the leading cause of death in U.S. hospitals, striking 750,000 Americans and killing between 28 and 50 percent of those people each year.
It can kill quickly and quietly. Warning signs also are characteristic of less-serious ailments, like high pulse rate and fever.
But simple, proactive measures can bring "a dramatic reduction in mortality," said Dr. Foster Gesten, medical director for the Office of Quality and Patient Safety in the state Department of Health.
Cuomo predicted that regulations that would ensure hospitals aggressively look for sepsis in patients could save between 5,000 and 8,000 New Yorkers a year.
It's this potential for improvement, coupled with an increase in sepsis cases over the last five or six years, Gesten said, that has created the supporting foundation for these regulatory moves.
But the death last year of a young boy from Queens also played a significant role in spreading public awareness and increasing pressure on hospitals to improve their practices for recognizing sepsis early.
In March, Rory Staunton cut his arm while playing basketball. The next day, the 12-year-old was feverish and vomiting, but was sent home from NYU's Langone Medical Center, diagnosed with dehydration and a stomachache.
Lab tests came back three hours after he was sent home, showing high levels of immature white blood cells, indicative of infection, but his family was not contacted with those results. His parents took him back to the hospital the next day, but four days after cutting his arm in his school's gym, Staunton died of severe septic shock brought on by the runaway infection.
Sepsis is treatable with heavy-duty antibiotics, but it requires prompt action. Once the body becomes flooded with immune responses, it can be difficult, if not impossible, to turn around.
"When our son died, we had never heard of sepsis," said Ciaran Staunton, Rory's father. "There's a killer in our midst that can be stopped. This was preventable." State health officials are drafting regulations, and the governor's State of the State address laid out some of those plans, such as the use of a checklist to flag those with signs of sepsis, a "countdown clock" for timely treatment and a requirement that New York hospitals publicly report the outcomes of the new protocols.
Such efforts already have proved effective at saving lives. When 55 hospitals surrounding the New York metropolitan area implemented similar measures, there was a 22 percent reduction in severe sepsis inpatient mortality rates, according to data from January 2011 to September 2012.
This success was part of the STOP — Strengthening Treatment and Outcome for Patients — Sepsis initiative, a joint campaign led by the Greater New York Hospital Association and the United Hospital Fund.
Lorraine Ryan, senior vice president of the hospital association, said that while she's "delighted" with the focus on sepsis, she hopes any treatment guidelines are given strong consideration before they are codified into law.
"We don't want to see regulation that is perfunctory and doesn't lead to improved outcomes," she said.
She noted that the state's proposal is unusual since "the regulations being considered are so specific to a clinical diagnosis," while regulations surrounding other conditions, such as HIV and cardiac care, have more to do with reporting outcomes than the specifics of treatment.
The health department's approval of the regulations is expected by this spring, following a public comment period.
After approval, hospitals will be expected to submit detailed plans on how they will implement the changes, and eventually, the health department will evaluate hospitals' adherence to their own measures, since, from a patient's point of view, what's most important is "whether the hospital actually managed to follow their own protocols, and to what success," Gesten said.
For the Stauntons, the regulations bring hope, and the family has set up the Rory Staunton Foundation to help spread awareness.
"No parents should ever have to bury their child because of this," Staunton said. "One day, there will be a last parent."
asanto@timesunion.com • 518-454-5008 • @alysiasanto

Published January 27, 2012 Times Union

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