National sepsis group adopts health equity pledge

By Christopher Cheney, HealthLeaders Media

The Sepsis Alliance has adopted an Equity, Diversity, and Inclusion Pledge.

Equity has been a longstanding issue in U.S. healthcare, but the coronavirus pandemic has heightened concern by exposing glaring disparity problems. In particular, African American and Hispanic people have experienced a disproportionate burden of illness and mortality during the pandemic.

Disparity is a major issue in sepsis care and outcomes, the president and CEO of the Sepsis Alliance recently told HealthLeaders.

"Sepsis is a huge burden on everyone. It is the No. 1 cause of death in hospitals. It is the No. 1 cost of hospitalization. It is the No. 1 cause of readmission to hospitals. Sepsis is a huge public health crisis. Then you magnify this crisis on certain minority communities, and you have something that is really dire," said Thomas Heymann, MBA.

The Sepsis Alliance has created a Sepsis and Health Equity Fact Sheet that highlights many racial, ethnic, and socioeconomic disparities related to sepsis. The fact sheet includes the following sepsis disparities:

• Black and other nonwhite people have nearly twice the incidence of sepsis as whites
   
• Non-Hispanic black children admitted to an emergency room are less likely to be treated for sepsis than non-Hispanic white children
   
• Native Hawaiians have almost twice the burden of sepsis mortality compared to whites
   
• Black children are 30% more likely than white children to develop sepsis after surgery
   
• Children with severe sepsis or septic shock who are black or Hispanic are about 25% more likely to die than non-Hispanic white children
   
• Adults below the poverty line have more than three to four times the risk of dying of sepsis compared to adults whose family income is at least five times the poverty line

"We understand equity as a systemic problem, so we cannot do a scatter-shot approach, which is what we had been doing in being more reactive than proactive in this area. Seeing the COVID-19 disparity data really brought it home to us. We got some funding to conduct a sepsis inequity literature review, and we saw startling differences in access, care, and outcomes," Heymann said.

Sepsis Alliance pledge

The San Diego-based organization adopted the following pledge last month: "Sepsis Alliance is committed to fostering equity, diversity, and inclusion (EDI) in our work and in the sepsis care community."

The Sepsis Alliance also adopted a three-point EDI plan.

1. Expand public education and provider training to close racial and ethnic gaps in sepsis awareness and ensure culturally responsive sepsis care: Goals for this part of the EDI plan include adding at least five new subject matter experts from communities of color to the organization's roster of presenters annually and providing implicit bias instruction in Sepsis Alliance Institute courses.

2. Pursue advocacy initiatives that further EDI goals and act as an EDI leader in healthcare: Goals for this part of the EDI plan include creating an industry EDI pledge by spring 2021 and creating an industry EDI reporting platform by spring 2021.

3. Boost diversity within the Sepsis Alliance to better reflect the communities that the organization serves: Goals for this part of the EDI plan include incorporating EDI into the Sepsis Alliance charter and conducting annual EDI training for the Sepsis Alliance's staff, board of directors, and advisory board.

Understanding and addressing sepsis disparities 

Several factors are driving sepsis disparities, Sandy Cayo, DNP, vice president of clinical performance and transformation at the New Jersey Hospital Association and a member of the Sepsis Alliance Equity, Diversity, and Inclusion Steering Committee told HealthLeaders.

• There is relatively less awareness about sepsis in minority populations compared to white Americans. In the Sepsis Alliance's most recent annual survey on sepsis awareness, only 5% of black respondents could identify the four most common sepsis symptoms and 18% of white respondents could identify the symptoms.
   
• There is a higher incidence and severity of underlying health factors among minority populations. African Americans and Hispanics often have more comorbid conditions including diabetes, hypertension, and respiratory problems such as chronic obstructive pulmonary disease.
   
• There are also "overlaying factors" such as lack of insurance and mistrust of providers that cause people of color to either not seek treatment soon enough or not get the proper treatment when they present to a healthcare provider with signs and symptoms of sepsis.
   
• "There have been studies that show that when people of color show up in emergency rooms, providers may not listen to them in the same way they might listen to their white counterparts. So, they may not be believed," she said.

To address sepsis disparities, healthcare providers need to elevate their awareness of equity issues and bias, Cayo said. "We need to put a lens of equity on how we approach care. We need to look at whether there is bias inserted and whether we could have eliminated it or addressed it."

Healthcare providers also need to communicate openly and regularly about equity and bias, she said. "It is important that we start talking about equity and bias. We are talking about it more than ever this year. We need to have these conversations upfront—it cannot be just for diversity and inclusion officers. All clinicians need to have equity and bias awareness as a priority in their approach to care."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders. This article originally ran on HealthLeaders.