Fewer Pa. patients die of sepsis, but report says 6 Philly-area hospitals struggle

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Hahnemann University Hospital was among six facilities with a higher-than-expected mortality rate from sepsis, according to a new state report.

Fewer patients are dying in Pennsylvania hospitals from 12 common conditions, according to a new state report.

The biggest improvement came among those diagnosed with sepsis, a potentially deadly inflammation in response to infection.

In fiscal 2016, 8.8 percent of sepsis patients died in the state’s hospitals, down from 15.4 percent five years earlier, according to the Pennsylvania Health Care Cost Containment Council — a trend physicians attribute to earlier diagnosis and fast treatment with antibiotics.

Still, at six hospitals in the Philadelphia area, patients with sepsis died at a higher rate than expected in the fiscal year that ended in September 2016, the state agency found.

They are Einstein Medical Center Philadelphia, Fox Chase Cancer Center, Hahnemann University Hospital, Hospital of the University of Pennsylvania, Jennersville Regional Hospital, and Mercy Philadelphia Hospital. Physicians attributed the higher-than-expected mortality to the complexity of their patients’ conditions.

[Read more: Sepsis: A stealthy, sudden killer]

Sepsis can be difficult to diagnose in its early stages, and its cause is often unclear, despite a nationwide effort to improve treatment. Each year, 1.5 million people develop sepsis in the United States and 250,000 die from it, according to the U.S. Centers for Disease Control and Prevention.

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The state agency evaluated each hospital’s performance based on how sick its patients were upon admission — factoring in such measures as age, blood test results, and the presence of chronic health conditions such as kidney disease. The agency calculated an expected mortality rate for each hospital, and determined whether each performed better than the expected rate, no different from expected, or worse.

But this practice, commonly called “risk adjustment,” is not always perfect.

At Hahnemann, physician Kevin F. D’Mello said one factor in the hospital’s higher-than-expected sepsis mortality rate was its complex patient population, in which drug use, homelessness, and chronic disease are not uncommon.

“It’s a patient population that needs a lot of help,” said D’Mello, director of quality improvement and patient safety in Drexel University’s department of internal medicine.

“You could have an infection that goes untreated for some time due to homelessness or whatever it may be, and you get a patient who is very sick upon admission,” he said. “As physicians, we’re kind of behind the eight ball at that point.”

Officials at HUP and Mercy Philadelphia also cited their patient populations to explain their performance in the study.

Patrick J. Brennan, chief medical officer for Penn Medicine, said internal data for 2017 show the hospital’s mortality from sepsis is 40 percent better than expected — success he attributed to an early-warning algorithm that predicts which patients will get sepsis as much as 30 hours in advance.

At Fox Chase, meanwhile, officials said sepsis posed a graver threat because patients’ immune systems could be weakened by their cancer treatments.

“Patients with cancer are naturally more susceptible to any type of infection due to side effects of chemotherapy,” said James Helstrom, chief medical officer.

Among area hospitals performing better than expected on sepsis mortality were the four in the Main Line Health system: Bryn Mawr Hospital, Lankenau Medical Center, Paoli Hospital, and Riddle Hospital.

This success was due to rigorous systemwide adherence to national treatment guidelines and the careful monitoring of internal data, said Andy Norton, chief medical officer.

Nurses and physicians paid special attention to how early signs of sepsis could vary in certain populations, Norton said. Symptoms in older patients in particular tend to be vague and can be mistaken for other conditions.

“They tend to have lower fevers,” Norton said. “They tend to feel nonspecifically not well.”

The four hospitals also focused on quickly testing for sepsis, allowing for swift administration of antibiotics where indicated, he said. Older patients are placed in the intensive care unit when appropriate, as they can decline rapidly.

Other conditions for which hospital mortality rates declined statewide included:

  • Respiratory failure, down from 15.9 percent to 9.7 percent.
  • Aspiration pneumonia, from 8.2 percent to 5.4 percent.
  • Heart attack, from 9.1 percent to 7 percent.