New York State Leads The Way In Sepsis Regulation

September 12, 2017|3:46 p.m.| ASTHO Staff

Howard Zucker, MD, JDIn May 2013, New York State became the first state to issue sepsis regulations, also known as “Rory’s Regulations,” mandating that all New York hospitals adopt, develop, and implement best practices for the early detection and timely treatment of sepsis. The regulations aim to equip hospitals with the systems and knowledge necessary to prevent harm or death to patients who are at risk of suffering from sepsis. ASTHO spoke with Howard Zucker, MD, JD, commissioner of health of New York State Department of Health, to learn more about statewide efforts to regulate sepsis. 

Please describe the processes that led to the actualization of sepsis regulations in the state of New York.

Thanks to the leadership of Gov. Andrew Cuomo, New York adopted Rory's Regulations in 2013 and became the first state in the nation to not only proactively fight back against the sepsis, but create a model that other states could follow. The regulations were named after Rory Staunton, a 12-year old boy from Queens, who died of sepsis in April 2012 after a fall in the school gym caused a skin abrasion that became infected.

What was a major challenge in implementing regulations for the rapid detection and treatment of sepsis? How did you overcome this challenge?

More than 750,000 Americans get sepsis each year, and over 200,000 die from it, making it the leading cause of death in hospitals and the eleventh leading cause of death overall in the United States, killing more people annually than AIDS, prostate cancer, and breast cancer combined. Given its prevalence and consequences, it was never a matter of whether New York State would lead the fight against sepsis, but rather how we would tackle this problem. By bringing together stakeholders from across the state, we enacted regulations that made a true impact in a short period of time. 

Data collection and reporting is a core aspect of patient safety and quality improvement. How beneficial was data in the program in New York State? What are your recommendations to improve the process?

A new study comparing quarterly data from 2014 and 2016 confirmed a 20 percent increase in the identification of sepsis patients from 10,970 at the onset of the study to 13,126 at its conclusion. In this same timeframe, mortality rates in adults steadily declined from 30.2 percent to 25.4 percent. The department will continue to focus not only on increasing hospital compliance rates with the regulations, but also work with the sepsis advisory group to further explore the specific clinical practices and delivery systems that have been most successful. This ranges from identifying innovative approaches to early identification of high-risk patients and rapid response of early interventions to new workforce sepsis training and education initiatives.

Were there educational and training requirements for New York State hospital staff, and if so, what were they?

Yes, the regulations require hospitals to report the manner and frequency with which they will provide initial and ongoing training to all hospital staff responsible for implementation of sepsis protocols in the emergency room and on inpatient floors. Hospitals must also describe how they make information technology resources available to assist in the implementation of protocols and the collection of required data for reporting to the department of health.

As commissioner, how did public health and healthcare leverage their respective strengths to develop and implement the policies designed to reduce sepsis mortality? How did you bring stakeholders in each discipline on board?

Recognizing that collaboration would be paramount to shifting the trend in sepsis care in New York State, the department convened an advisory group made up of clinicians from across the state with expertise in both adult and pediatric care of patients with sepsis. The advisory group provided invaluable input to assist in structuring the protocols and performance reports. 

What best practices can you share with other states that are looking to take this approach to decrease their sepsis mortality rates?

The department’s report on sepsis care is truly a testament to the commitment by New York’s hospitals to improving the care of patients with sepsis. The hospitals, coupled with the sepsis advisory group and the Staunton family, were a tremendous resource in developing and implementing the regulations.