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Diane Craig, MD

Hospital Medicine, Santa Clara

Sepsis Management

“The greatest reward was watching the mortality rate for sepsis fall as we got better at identifying patients quickly and treating them aggressively.”

Stealthy and swift, sepsis is the number one cause of death in hospitals nationwide. The protocol for sepsis management sounds simple: screen patients with infections for abnormal vital signs and lactic acid levels; if they meet criteria, initiate treatment with intravenous fluids, antibiotics and a central line to monitor response to treatment.

But as Dr. Craig explains, “one of the challenges is that patients with severe sepsis often look good, until all of a sudden they don’t. Those patients whose lactate levels are above four need aggressive treatment, even if they are lying on the gurney reading the newspaper.”

Dr. Craig worked with a multidisciplinary team to develop tools to better diagnose and treat sepsis. They added a test for lactic acid to blood culture orders, and instituted an alert to assemble clinicians to assess the patient and, if appropriate, begin early goal-directed therapy.

Within a year, mortality from sepsis had declined by 50% at Santa Clara, and the best practices the team pioneered were being shared with medical centers.

The team continued to build on their success. They created a “sepsis clock” to ensure the multiple components of the new protocol are completed within a six-hour timeframe; and they stressed the importance of monitoring patients with intermediate lactate levels to help prevent severe sepsis.

Dr. Craig’s focus on sepsis has saved lives at Santa Clara, and has contributed to the dramatic decline in sepsis mortality throughout KP Northern California, where the rate is currently 28% below the national average.

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