Practical tips for reducing Sepsis-related malpractice risk

Sepsis is a serious medical condition that affects more than 1 million Americans each year and leads to more than 258,000 annual deaths. And though the number and rate of hospitalizations for sepsis is on the rise, many consumers have never even heard of sepsis.

Combine that general lack of knowledge with the often devastating, long-term aftereffects of the condition – such as limb amputations – and it's easy to see why sepsis cases result in a high frequency of medical malpractice claims that are associated with large settlement and judgment amounts.

In addition to providing excellent sepsis care, there are further steps hospitals and physicians can take to reduce the significant financial risks of sepsis-related malpractice lawsuits.

Sepsis overview
According to the Centers for Disease Control and Prevention, sepsis is "the body's overwhelming and life-threatening response to an infection, which can lead to tissue damage, organ failure and death."

Arising from various and even minor infections – such as skin infections, pneumonia or urinary tract infections – sepsis is highly treatable when identified early. But its symptoms can mimic other conditions, making it difficult to diagnose. And left untreated, sepsis can progress quickly.

As sepsis has become more prevalent, efforts such as the Surviving Sepsis Campaign have helped improve clinical processes to reduce the mortality rate. While this is inarguably positive news for patients and the entire medical community, it also means an increase in the number of patients who may be living with aftereffects of sepsis, such as cognitive impairment, organ dysfunction and limb amputations. In addition, sepsis survivors have an increased risk of death even several years later.

Malpractice landscape
Few patients and families are aware of the possible consequences of sepsis, and thus may assume medical misadventure is the cause of their resulting health challenges. This prompts some patients to pursue litigation against hospitals and physicians.

Generally speaking, medical malpractice trial outcomes tend to favor the defendants 9:1. But that's not the case for sepsis. The medicine is complex and subject to retrospective bias, and the plaintiffs, with their associated disabilities and disfigurement, are often very sympathetic to the jury of laypeople who must sort through medical expert testimony. Sepsis is very complicated for healthcare providers, so how can one expect jurors to fully understand this disease process?

Enhance communication
Providing high quality sepsis care and optimizing healthcare providers' ability to identify patients at risk for sepsis are always of critical importance. But fully relying on diagnostic accuracy is a flawed strategy.

First, healthcare providers should take extra steps to communicate with their patients about sepsis.

Again, a large portion of the population has never even heard of sepsis. An international survey published in Critical Care Medicine in 2009 showed a mean of 88 percent of interviewees in Italy, Spain, the United Kingdom and the United States had never heard of sepsis. Further, for those who had heard of it, 58 percent did not recognize that it is a leading cause of death.

Therefore, physicians must be good bedside educators for patients and their families, sharing information on sepsis, answering questions, and appropriately conveying that sepsis is not a short-term affliction that will be "cured" upon hospital discharge, but often a long-term disease process that increases the risk of health complications, and even death, years after the event.

In addition, physicians should communicate with patients who are at heightened risk of developing sepsis. Because it is difficult to diagnose, some patients may have early sepsis before it's readily apparent, and some patients may develop the condition later. If there is no communication about sepsis, the logical assumption is that the physician never considered it.

A simple conversation explaining sepsis and its associated risks, and letting the patient know what signs and symptoms to watch for, along with specific "watch out for sepsis" aftercare instructions, are valuable communication tools. Research has shown that this kind of improved communication is associated both with improved outcomes and a reduction in malpractice lawsuits.

Instituting informed consent
In some cases of sepsis, physicians must administer a type of medication called a "vasopressor." These drugs constrict peripheral blood vessels, increasing blood pressure and diverting blood flow to the vital organs. Sepsis itself reduces oxygenated blood flow to the extremities, which may result in the loss of digits and/or limbs. The use of vasopressors likely exacerbates this phenomenon.

When possible, patients and families should be informed and consent to vasopressor use prior to its administration.

Hospitals and physicians can reduce their risk of alleged negligence by instituting an informed consent process when using vasopressors for patients with sepsis. That means conducting an informed discussion about the benefits and risks of vasopressors before administering these drugs and documenting that discussion in the patient's medical record.

Some physicians and hospitals use a consent form, where the patient or representative signs that they will accept treatment. However, the form itself is not enough. The discussion with the patient is the critical piece to ensuring the patient is truly informed.

Providing leadership and support
Hospital and physician executives can facilitate these improvements by supporting the adoption of policies and protocols around informed consent and helping create a culture that values communication. More broadly, they can help physicians avoid common pitfalls by sharing timely knowledge on important trends and topics like sepsis.

One example of this type of timely communication is TeamHealth's "Risk Management Alert" series—an ongoing series of articles, videos and tools designed to keep the organization's more than 19,000 clinicians updated on current clinical issues.

Again, sepsis affects a large and growing number of Americans each year and carries with it long-term and frequently devastating health consequences. To reduce the likelihood of medical malpractice allegations and improve the defensibility of the care provided, healthcare providers, with the support of hospital leadership, should enhance patient communication and utilize an informed consent process related to sepsis treatment.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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