Home Care Association of New York State
Home Health Sepsis Screening and Intervention Initiative
A National First in Sepsis Intervention through Home & Community Based Care
“Sepsis is the body’s overwhelming and life threatening response to infection. It can
lead to tissue damage, organ failure and death.” (Sepsis Facts; national Sepsis Alliance)
“Sepsis is a medical emergency. Sepsis is deadly when not quickly recognized and
treated.” (Vital Signs; US Centers for Disease Control and Prevention)
NYS is first in the nation to adopt requirements for hospital sepsis protocols “Rory’s Regulations,” and statewide education “Rory’s Law.” (Rory Staunton Foundation for Sepsis Prevention)
80% ‐ 90% of sepsis cases originate in home and community. (Sepsis Alliance/CDC)
While anyone ‐ young, old, healthy, ill can develop sepsis – it is most prevalent in or within the reach of the home and community based health care system.
HCA and partners have created and implemented the first in the nation statewide sepsis screening and intervention initiative by home and community based care providers.
Leveraging home health care to help stop sepsis will be a game‐changer for lives and health costs.
The HCA Home Care Sepsis Initiative
In 2017, the Home Care Association of New York State (HCA), in conjunction with core partners – IPRO, national Sepsis Alliance, the Rory Staunton Foundation for Sepsis Prevention, and a host of state and national partners – initiated a bold and potentially paradigm‐shifting initiative: creating and launching the nation first screening and intervention protocol for sepsis through the statewide home health care system. The tool was created by an expert clinical workgroup of HCA in home care and in sepsis, including input and guidance from top state and national physicians in sepsis including Sepsis Alliance and sepsis advisors to NYS, and provider clinical directors.
The initiative has been further guided by an HCA‐convened steering committee consisting of national and state sepsis leaders, statewide representatives from nearly every health sector (hospitals, physicians, emergency medical services, health plans/insurance companies, consumers, state agencies, sepsis advisors to CDC, and the aforementioned core partners), and was awarded a statewide training and implementation grant by the NYS Health Foundation.
Led by HCA and core partners, in less than two years’ time, the initiative has trained and led to the adoption of the HCA Sepsis Tool by home care agencies serving 55 of NY’s 62 counties (see map on next page), with efforts ongoing to implement in the remaining counties and by all applicable NY providers. HCA’s goal: statewide adoption of this Tool as a basic standard of practice by all home care (and other applicable) providers in NYS, through education, technical guidance and assistance. HCA continues to encourage all applicable New York State providers to adopt this tool and to integrate it into their practices with EMS, physicians, hospitals and other key partners. HCA also encourages managed care plans to adopt the tool as part of their Value Based initiatives, and for the managed care plans to in turn seek the
participation of their network providers.
The HCA Sepsis Tool and Components
The HCA Sepsis Tool is an assessment instrument created by an HCA clinical workgroup over a period of several years through research and medical guidance from top sepsis clinicians in NY and nationally. The Tool is created for use specifically by home care clinicians, but may also be used in other ambulatory and long term care settings. It is comprised of a screening tool instrument, an algorithm, standard protocol, and patient education zone tool.
The Sepsis Screen is used at every clinical home care visit to assess for: (i) history, presence, risk or potential source sites of infection, (ii) systemic criteria, and (iii) indications of new onset organ dysfunction. The tool respectively follows the SIRS criteria and q‐SOFA criteria, consistent with the criteria utilized by NYS hospitals under the state’s hospital sepsis protocol (Rory’s Regulations).
The Algorithm guides the clinicians through follow‐up and intervention.
The Protocol ensures adherence to the standardized application of the tool and algorithm.
The Education Zone Tool is used for patient education, management and prevention, and is also utilized to train home health aides, family caregivers and non‐clinicians who may be involved in the care of the patient. The Zone Tool was developed and incorporated in this initiative through the work of IPRO in conjunction with its implementation of a Centers for Medicare and Medicaid Services sepsis early recognition and intervention special innovations project conducted in NY.
HCA’s Sepsis Initiative is also accompanied by a Data Analysis and Research Component where providers are able to compile and analyze risk factors and findings information from application of the sepsis tool, and where aggregate deidentified results can be used to contribute to evaluation, improved practices, collaborative work with clinical partners and the state’s epidemiological analyses.
The HCA Sepsis Initiative is further supported by a dedicated home care sepsis website Stop Sepsis At Home NY.
The HCA home care sepsis innovation is synchronized to New York’s first‐in‐the-nation statewide hospital protocols (“Rory’s Regulations”) for sepsis derived from the work of the Rory Staunton Foundation, established in legacy to 12‐year old Rory Staunton who developed sepsis after a cut playing basketball led to infection, progressing to sepsis, and Rory’s tragic passing after symptoms not recognized by the treating medical community led to septic shock. Rory’s tragic loss led his parents, Orlaith and Ciaran Staunton to pioneer work in NYS and in the country to save lives.
Synchronizing to Rory’s Regulations
Serious Sepsis Facts:
1.7 million cases each year in the U.S.
270,000 deaths each year –more than breast cancer, prostate cancer and AIDS – combined.
Commonly misunderstood as a “hospital problem, whereas 80% ? 90% of sepsis cases originate in home and community.
Every 2 minutes someone in the US dies of sepsis.
Takes more children than cancer – 18 kids each day.
#1 cost of hospitalization ? $27B/yr.
Every 20 seconds someone is hospitalized with sepsis.
#1 cause of death in U.S. hospitals.
#1 driver of readmission to a hospital (30 days)
#1 Medicaid expense for potentially avoidable hospitalizations for general MA population in NYS hospitals and #2 in Medicaid hospital expense nationally (after Liveborns).
1 in 4 hospital patients treated for sepsis is readmitted in the first 30 days after discharge.
Up to 50% of sepsis survivors suffer from postsepsis syndrome, with consequences for ongoing primary and community care.
US DHHS estimates that sepsis results in an average of 38 amputations each day.
Mortality increases 8% every hour that treatment is delayed.
Early identification and treatment are the key to improved outcomes and reduced costs.
Big opportunity lies in public awareness and primary providers’ education and training.
Among highest risk groups are individual most commonly within or within the reach of the health care system.
Sources: Sepsis Alliance, US CDC, US DHHS, Rory Staunton Foundation