Kevin Tracey, MD, was trained as a neurosurgeon. In 1985, at what was then New York Hospital Cornell Medical Center, an 11-month-old girl was brought in with severe burns after a boiling pot of spaghetti water splashed onto her skin. After a month of fighting, she died in Dr. Tracey's arms. He didn't know it then, but the moment would define his life's work researching sepsis.
Now, president and CEO of the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, N.Y., Dr. Tracey continues his work, researching the No.1 killer in America's hospitals. He also helped found the Global Sepsis Alliance.
Things have come a long way since then, but sepsis still kills 270,000 hospital patients each year and 1.7 million patients develop the condition in hospitals annually.
"When I started this work, sepsis mortality hovered around — dependent on complicating conditions — anywhere between 40% and 60%. None of us… I mean, no one understood it, No one knew what to do," Dr. Tracey told Becker's. "Now we understand a great deal more about successfully treating patients with sepsis, and the mortality rate is much less than that today. The impact of the lives saved over the decades of this work is significant, but there's more to be done."
Both Dr. Tracey and Steven Simpson, MD, chair of the Sepsis Alliance Board of Directors and a professor of medicine at the University of Kansas, have been involved in advocacy for more to be done at a federal level to address sepsis in hospitals.
"It's been a long time coming, but I'm one of the people who have been beating the drum for two decades, so to me, the new guidelines… it's still not enough response. It will take vigorous efforts," Dr. Simpson told Becker's. "I am glad to see more attention on this from CMS and the CDC, and glad to see more intention on this issue."
A call to action for hospitals
As part of new CMS rules that take effect in 2026, hospitals must adopt additional safety measures for sepsis care outlined by the agency to continue to receive certain funding.
Some organizations, including the American Hospital Association, have pushed back on some specifics of the rules, but at the end of the day Dr. Tracey said the issue is not necessarily one of resources, but rather "it's about changing processes."
"Let's start with the facts. Hospitals are under increasing financial pressures from declining reimbursements from the federal government and from insurance providers. It's a very, very, very unforgiving and difficult business," he said. "I can't make a specific recommendation, of course, on how hospitals prioritize these precious resources, but I can speak to the fact that if you deploy and launch metric-driven treatment of patients with sepsis that you will save lives. And if you're saving lives, it's quite likely that you're shortening hospital stays and reducing costs too."
The CDC has also launched a new program in August 2023 that focuses on enhancing sepsis care and improving patient outcomes in hospitals nationwide.
"To implement the new requirements, hospitals will have to invest in creating a robust program where leaders and team members have dedicated time and the resources to address sepsis," Namita Jayaprakash, head of Henry Ford Health's sepsis program, said to Becker's. "The CDC's core elements provide a great guide for areas to focus on."
Both the CMS rules and the CDC hospital program are part of increasing pressures from the government on hospitals and health systems to do more to reduce these outcomes. National sepsis guidelines exist in other countries, but it's something the U.S. has for the most part lacked, which is where organizations like the Sepsis Alliance step in to advocate for policy and help craft strategies for healthcare leaders to follow.
"If you're in a big complicated hospital, and you don't have a system in place for sepsis, but think you have a case — from the time the order for antibiotics is placed until the time the pharmacy receives the order, until the time that the antibiotic is processed, to the time it is brought back to the floor, to the time that is hung on IV pole and plugged into the patient…you might not make that window of critical treatment time," Dr. Tracey said. "The hospital at all levels has to be engaged in a plan. Everyone at the medical staff level and at the administrative level have to accept the urgency of sepsis and treat it that way. And then, in order to know that you're doing it effectively, you have to follow metrics, which is what these CMS and other proposals like from the CDC are about."
The work is far from complete
Major health systems, including Henry Ford Health in Detroit, Mich., ChristianaCare in Newark, Del., and Northwell Health, have doubled-down on measures to do their part to work toward reducing sepsis deaths, including everything from employing ED nurses in more direct ways for detection, using technology and changing workflows.
Part of the difficulty with sepsis is that it typically isn't the reason a patient seeks care, but develops as the result of infection in the body and can become deadly within just 12 hours.
Now, with advancements in technology, researchers are testing and developing various "rapid sepsis detection" tests with the aim to serve as more of a guiding map for clinicians as they do their best with the strategies and collaboration they develop around sepsis internally.
In August 2023, Baton Rouge, La.-based Our Lady of the Lake Health became the first hospital in the nation to deploy a 10-minute rapid sepsis test. After just one month of use, physicians at the hospital told Becker's in a previous interview that it had already helped clinical teams prioritize faster care for 15 at-risk individuals.
While technology will be of great aid to clinicians, there's still a lot about sepsis physicians don't understand, and are working to.
"Sepsis has been an under-resourced area in hospitals for far too long," Dr. Jayaprakash said. "The potential to impact lives is so significant that the focus and change in prioritization is long overdue."
The next challenge Dr. Tracey and others are staring down in the fight against sepsis is on the outcomes of survivors, many of whom develop neurological and cognitive impairments and have higher mortality rates.
"When you look at how many people survive sepsis, and it's hundreds of thousands in the United States alone, these survivors, they have a 50% mortality rate within five years," he said. "That's a staggering number. And many don't go back to work because they have severe cognitive impairments and other disabilities — some cardiac and real disabilities. We need to rethink what that means. We don't understand. None of us know the reason why that mortality is so high."