The Home Care Association (HCA) of New York State has awarded its Statewide Physician Champion Award to Northwell Health’s Martin E. Doerfler, MD, for his work in reducing sepsis mortality in the home health field. Sepsis is a life-threatening condition caused when the body’s immune system wages an over-aggresive response to an infection, often causing injury to the body’s organs. Known as the “silent killer,” sepsis affects more than a million Americans annually — 15-30 percent of whom will die.
As senior vice president of clinical strategy and development at Northwell Health, Dr. Doerfler spearheaded efforts that have reduced sepsis mortality in the health system’s hospitals by 68 percent over the past decade. Based on protocols he helped establish for the early diagnosis and treatment of this life-threatening condition, he was also instrumental in helping HCA establish the Home Health Sepsis Screening and Intervention Initiative, which began in 2017 as a partnership with IPRO, the national Sepsis Alliance, The Rory Staunton Foundation for Sepsis Prevention, and national and state organizations.
As a result, the HCA Sepsis Tool was created — an assessment instrument used specifically by home care clinicians to evaluate history, presence, risk or potential source sites of infection, systemic inflammation criteria, and indications of new-onset organ dysfunction. The tool includes a screening instrument, algorithm, standard protocol and a patient education tool, and follows systemic inflammatory response syndrome (SIRS) and quick Sequential Organ Failure Assessment (q-SOFA) criteria.
“This award recognizes Dr. Doerfler’s transformative work with HCA and the home health field,” said Al Cardillo, HCA president and CEO. “He provided medical expertise, extensive time and leadership in developing this national-first sepsis screening and intervention tool and protocol through the home and community health system.”
Throughout the initiative, Dr. Doerfler served as a core medical adviser on HCA’s Sepsis Steering Committee. He also keynoted HCA’s 2014 Quality Symposium, where he addressed the importance of recognizing sepsis and early intervention. “He made himself available virtually ‘on-call’ to provide guidance in this home health sepsis effort,” Mr. Cardillo said.
Dr. Doerfler, who started his medical career as a sepsis researcher looking for the “silver bullet” treatment, was a catalyst to Northwell’s success in reducing mortality among hospital patients contracting sepsis from 35 percent in 2008 to 11 percent in 2018, which reflects an approximately 68 percent decrease. Northwell hospitals treat approximately 1,000 sepsis cases each month, so these efforts have saved thousands of lives over the years. “The work that Northwell has been able to achieve over the last decade has been extraordinary. I’m honored and humbled as the one person being recognized for all of the work that thousands of people are doing,” Dr. Doerfler said. “Working with HCA on its sepsis initiative has brought to home care the kind of rigor and evidence-based protocols that have made a difference in the hospital setting, and I am proud to see the outcomes already being observed by this groundbreaking endeavor.”
Northwell’s achievements began in 2009 when the health system instituted protocols aimed at early identification of the condition, which is characterized by such symptoms as fever, difficulty breathing, low blood pressure, fast heart rate and mental confusion. A year later, Northwell’s Feinstein Institutes for Medical Research hosted the Merinoff Symposium, which joined more than 150 scientists, physicians, policymakers and other sepsis experts from 18 different countries as the first worldwide consensus on how to define sepsis and best practices to fight the disease.
In 2011, Northwell began partnering with the Institute for Healthcare Improvement to test new ways to prevent sepsis and manage its most harmful effects through earlier recognition. All of Northwell’s emergency departments (ED) began testing and reengineering processes to decrease “door-to-doctor time” in the ED, identify and remove impediments to the administration of early antibiotics, track and modify processes to get lactate test results back to physicians within 90 minutes, and start fluids quickly with appropriate volumes given.
“Marty has been a phenomenal leader within the health system and we have made a lot of progress in attacking sepsis head on,” said Michael Dowling, Northwell president and CEO. “The statistics are still glaring nationwide, so this fight is not finished. We must continue to improve the tools, algorithms and education necessary to eradicate sepsis from hospitals and home care settings.”
Last week, the state Legislature approved legislation to put further backing behind the HCA sepsis tool and initiative, including HCA’s emphasis on bringing home health providers and other caregivers together to collaborate and coordinate on sepsis prevention, intervention and follow-up care. The bill mirrors joint work modeled by HCA and Dr. Doerfler. It also coordinates into these efforts key sepsis leaders like Sepsis Alliance and the Rory Staunton Foundation.