A state-wide implementation of a whole of hospital sepsis pathway with a mortality based cost-effectiveness analysis from a healthcare sector perspective

Natasha K Brusco; Kelly Sykes; Allen C Cheng; Camilla Radia-George; Douglas Travis; Natalie Sullivan; Tammy Dinh; Sarah Foster; Karin Thursky; Safer Care Victoria “Think sepsis. Act fast” Scaling Collaboration

doi:10.1371/journal.pgph.0000687

A state-wide implementation of a whole of hospital sepsis pathway with a mortality based cost-effectiveness analysis from a healthcare sector perspective

PLOS Glob Public Health. 2023 May 19;3(5):e0000687. doi: 10.1371/journal.pgph.0000687. eCollection 2023.

Authors

Natasha K Brusco^{1

2

3}, Kelly Sykes⁴, Allen C Cheng^{5

6

7}, Camilla Radia-George⁸, Douglas Travis⁹, Natalie Sullivan^{2

3

8}, Tammy Dinh⁴, Sarah Foster^{3

10}, Karin Thursky^{11

12

13}; Safer Care Victoria “Think sepsis. Act fast” Scaling Collaboration

Affiliations

¹ Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.
² College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.
³ Health Economics Department, Alpha Crucis Group, Langwarrin, Australia.
⁴ Department of Health, Victoria State Government, Melbourne, Australia.
⁵ Monash Infectious Diseases, Monash Health and School of Clinical Sciences, Monash University, Clayton, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
⁷ Department of Infectious Diseases, Alfred Health, Melbourne, Australia.
⁸ EACH, Ringwood, Australia.
⁹ Department of Medicine, Western Health, Melbourne, Australia.
¹⁰ Department of Infection Control, Peninsula Health, Frankston, Australia.
¹¹ Guidance Group, Royal Melbourne Hospital, Melbourne, Australia.
¹² Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
¹³ Department of Health Services Research, Deputy Head of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.

Abstract

With global estimates of 15 million cases of sepsis annually, together with a 24% in-hospital mortality rate, this condition comes at a high cost to both the patient and to the health services delivering care. This translational research determined the cost-effectiveness of state-wide implementation of a whole of hospital Sepsis Pathway in reducing mortality and/or hospital admission costs from a healthcare sector perspective, and report the cost of implementation over 12-months. A non-randomised stepped wedge cluster implementation study design was used to implement an existing Sepsis Pathway ("Think sepsis. Act fast") across 10 of Victoria's public health services, comprising 23 hospitals, which provide hospital care to 63% of the State's population, or 15% of the Australian population. The pathway utilised a nurse led model with early warning and severity criteria, and actions to be initiated within 60 minutes of sepsis recognition. Pathway elements included oxygen administration; blood cultures (x2); venous blood lactate; fluid resuscitation; intravenous antibiotics, and increased monitoring. At baseline there were 876 participants (392 female (44.7%), mean 68.4 years); and during the intervention, there were 1,476 participants (684 female (46.3%), mean 66.8 years). Mortality significantly reduced from 11.4% (100/876) at baseline to 5.8% (85/1,476) during implementation (p>0.001). Respectively, at baseline and intervention the average length of stay was 9.1 (SD 10.3) and 6.2 (SD 7.9) days, and cost was $AUD22,107 (SD $26,937) and $14,203 (SD $17,611) per patient, with a significant 2.9 day reduction in length of stay (-2.9; 95%CI -3.7 to -2.2, p<0.01) and $7,904 reduction in cost (-$7,904; 95%CI -$9,707 to -$6,100, p<0.01). The Sepsis Pathway was a dominant cost-effective intervention due to reduced cost and reduced mortality. Cost of implementation was $1,845,230. In conclusion, a well-resourced state-wide Sepsis Pathway implementation initiative can save lives and dramatically reduce the health service cost per admission.

Copyright: © 2023 Brusco et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The collaboration was established by Safer Care Victoria (SCV) and funded by the Better Care Victoria (BCV) Innovation Fund (funds received by NB and NS). The Funding body did not have input into the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. In addition, we confirm the independence of researchers from funders and that all authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.