Sepsis is a global health dilemma, accounting for 5.3 million deaths and a significant financial burden on the healthcare system. Early detection and accurate prognosis of sepsis are critical for positive patient outcomes. The significant role of the clinical laboratory in the detection and prognosis of sepsis cases was highlighted in yesterday’s scientific session, “Sepsis: Laboratory Medicine’s Collaborative Role in Risk Stratification, Early Detection, and Positive Patient Outcomes.”Octavia Peck-Palmer, PhD, DABCC, FADLM, kicked off the session with strategies that clinical laboratories can employ to accurately detect sepsis. “Regular review of the literature and in-house patient data is the key to identifying gaps in care and assessing how testing algorithms may improve patient outcomes,” she said. Peck-Palmer detailed how laboratories can employ data analytics approaches to electronic medical records in order to alert clinicians. Other ideas: offer a panel of physicians’ favorite tests for sepsis to ease orders, and develop a STAT sepsis ordering method.
Peck-Palmer noted that clinical laboratorians should be knowledgeable and explain to clients the limitations of sepsis biomarkers. The laboratory team should determine if the test result turnaround time meets the provider’s needs and if the types of interpretation accompanying the test results and the testing algorithms are user-friendly. “Clinical laboratories and stakeholders should clearly understand how current state, federal, and society guidelines align or misalign with test reimbursement,” Peck-Palmer said.
The second speaker, Stephanie Mitchell, PhD, D(ABMM), highlighted the partnership between the lab and the antimicrobial stewardship program. Antimicrobial resistance (AMR) reporting, such as laboratory testing for methicillin-resistant S. aureus, has significantly enhanced the effectiveness of antimicrobial therapy and appropriate de-escalation of vancomycin, a broad-spectrum antibiotic with serious toxicity.
In her presentation, Mitchell discussed the role of a multidisciplinary team of laboratory leaders in chemistry, hematology, and microbiology as well as physician stakeholders in critical care, infectious disease, antimicrobial stewardship, and emergency medicine. This team can establish a well-rounded approach for detection and treatment of sepsis. “Early engagement and discussions up front, ensuring representation of each stakeholder is present, adherence to guidelines, and quality assurance are all important to a successful and sustainable protocol,” Mitchell explained.
Interestingly, the Clinical and Laboratory Standards Institute (CLSI) is developing a new document, GP50, “Clinical Testing for Early Detection and Management of Sepsis.” Both Peck-Palmer and Mitchell are on the committee as chair and vice-chair, respectively. The committee members aim to fill several gaps with this document. This includes: i) educating clinical laboratories on the definition of sepsis, ii) empowering the laboratory to take a leadership/stakeholder role in providing guidance to clients as to the appropriate testing algorithms that will be employed for the patient population within their institution, iii) empowering the laboratory to assess test menus and relevant timetables around the delivery of results needed to comply with detecting sepsis, iv) highlighting the laboratory as a consultant for test selection and interpretation, and v) ensuring sepsis protocols are aligned within and across the healthcare system.
This session highlighted the collaborative nature of the clinical laboratory in helping diagnose sepsis. Attendees left the session with a better understanding of the limitations of current sepsis biomarkers, as well as practical tips to implement strategies to help detect sepsis at their own laboratories.