Slow and steady wins the race, but in the case of sepsis a little more speed would be handy, both for patients and the nation’s back pocket.
Sepsis is more prevalent, more deadly and more costly than previously understood, according to a new report from the Australian Commission on Safety and Quality in Health Care.
The Sepsis Epidemiology Report, published today, analysed over 900,000 sepsis-related hospitalisations in Australian public hospitals from 2013–14 to 2022–23.
“In 2022–23 alone, there were over 84,000 sepsis hospitalisations and more than 936,000 hospitalisations over the 10-year reporting period. This is significantly greater than the previous estimate of 55,000 people affected each year,” said the report.
What it also found was that although sepsis rates have dropped to 27 per 10,000 population in 2022-2023 from a peak of 38 in 2013-2014, and the length-of-stay and in-hospital mortality have stayed much the same, the average cost of a sepsis separation has increased by 50% over a 10-year period.
“Managing comorbidities and sepsis in the context of complex social determinants and intersectionality may be driving increased resource utilisation,” said the report.
The report also found that patients with chronic and complex health conditions were at greater risk and were harder to treat.
“Almost one in three admissions for sepsis also had diabetes,” it said.
“Notable proportions of those treated for sepsis in hospital also had renal disease or cancer.
“The average length of stay for patients with sepsis as a secondary diagnosis was almost twice that of patients with a primary diagnosis. This cohort was also more likely to be admitted to ICU and have longer ICU stays.
“Over half of all post-sepsis readmissions over a 12-month period occurred in the first 30 days after discharge. Of those who returned in the 30 days after sepsis, at least one in five were treated for sepsis again.
“Analysis confirmed that older people or aged care residents were more likely to be admitted to hospital and treated for sepsis.”
Aboriginal and Torres Strait Islander people were also more likely to be hospitalised for sepsis.
“The latest analysis period of 2022-23 saw 5753 sepsis separations for Aboriginal or Torres Strait Islander patients,” said the report.
That translated to about six sepsis separations per 1000 Aboriginal or Torres Strait Islander people, double that of the non-Indigenous rate.
Social determinants appear to affect readmission risk, wrote the report authors.
“Hospital transfer data suggests that rural living and higher socio-economic disadvantage are important risk factors associated with 30-day readmission,” they wrote.
Conjoint Professor Carolyn Hullick, chief medical officer of the Commission and an emergency physician, said the findings were a call to action.
“Sepsis is a time-critical emergency,” she said.
“Our report shows that many Australians face not only a high risk of death, but also long recovery periods and repeat hospitalisations.
“We must do more to reduce the impact of sepsis on health services and improve patient outcomes and support health services in early recognition, treatment and discharge planning.
“The link between complex chronic illness, socioeconomic disadvantage and higher rates of sepsis must shape how we deliver care.
“This data gives us a clearer picture of who is most at risk and how to intervene earlier.”
To that end, the report made some suggestions for future directions:
- Collaboration to reach priority groups: “Partnerships with chronic disease associations such as Diabetes Australia, Kidney Health Australia and Cancer Australia may help to ensure that future sepsis awareness efforts reach those most at risk. Health services should also consider targeted quality improvement initiatives in chronic disease services/clinics”.
- A National Sepsis Data Plan: “The quality and utility of sepsis data will be enhanced by: (a) consensus on the exact code combinations to define sepsis; (b) inclusion of recommended ‘Minimum Core Set of Cultural and Language Indicators’; (c) data linkage including mortality sources, private hospital data, emergency department; and (d) presentations and post-hospital follow up care”.
- Jurisdictional analysis: “Improving identification and management of complex infection cases, and the transfer of information across hospital systems may equip health services to evaluate the likelihood of a patient developing sepsis, and/or mitigate a subsequent sepsis hospitalisation. Jurisdictions should also consider targeted subgroups, exploring local variation in hospital, geographic and patient level data to identify opportunities for local quality improvement including ways to strengthen health equity. Tailored analysis of specific populations may also help health services better assess the prevalence and impact of sepsis on those groups. This includes paediatric and neonatal cohorts to ensure that the insights about risk factors are not masked by the weight of adult patient data”.
Read the full report here.
