Case Study: The Dangers of Assumption in Sepsis Cases

By: Sarma Velamuri, M.D., Mihir Pethe

Dec 8th 2020

Consider the case of an 82-year-old woman with a history of heart block who had a pacemaker implanted four years ago. She comes to the ER with her 48-year-old son, who is her primary caregiver. She appears confused and fatigued, although her son says she is normally alert and engaged with her family, and normally takes care of herself. Her son is worried she may have had a mild stroke because of her unusual altered mental state. To the clinicians, she appears to be struggling to breathe, even though her respiratory rate appears normal on the monitors.

Immediately there are a variety of decisions the clinicians need to make, each of which can set this patient down a variety of paths. Let us examine two potential pathways this patient could follow, and what decisions lead us down each path.

Current Workflow & Outcome

  1. Clinicians see the patient’s condition, factor in family concerns, and screen for the most likely issue: stroke
  2. A stroke workup is done and comes up negative
  3. Sepsis is not considered in the screening process, and the proper bloodwork to diagnose it is not ordered.
  4. The patient is sent home despite having sepsis, a condition where every minute is critical in determining the outcome.

Ideal Workflow & Outcome

  1. This patient has a pacemaker, and the screening tools the staff use account for the fact that her heart rate will remain “normal” although she may in fact be septic.
  2. Her acutely altered mental status alert hospital staff of potential for both stroke and sepsis, and imaging and a full complete blood count with coagulants is ordered to rule out stroke.
  3. The patient is put on a nasal canula based on the observed tachypnea.
  4. Additional bloodwork confirms sepsis and the patient is placed on the necessary antibiotics

To prevent the patient from falling through the cracks, it is important to screen patients for sepsis. In Luminare’s Sagitta platform, this patient would have been screened positive for SIRS, warranting more investigation. That small step could be the difference between saving the patient’s life or not. At best, screening would catch sepsis early and allow it to be treated, while at worst would mean a few extra hours of observation.

The ideal system will be able to look at a holistic account of the patient, considering the patient data, family knowledge, caregiver notes, and information from medical providers. Sagitta can consider observational clinical data, which is particularly valuable in geriatric cases like this one.

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