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Critical Care Clinical Nurse Specialist Angela Craig

Liz Engel Clark
Friday, Jul 6, 2012

Angela Craig.

A Cookeville Regional Medical Center nurse is speaking out about sepsis and that campaign was recently heard on a national level.

Angela Craig, a clinical nurse specialist in the intensive care unit (ICU) at CRMC, was selected to speak at the recent American Association of Critical-Care Nurses’ National Teaching Institute (NTI) conference, held May 20-24 in Orlando, Fla. While Craig was among the many presenters, her topic is definitely one that touches every hospital in the country: sepsis.

Sepsis is a serious infection that’s a common cause of death in critical care units. The presentation, three-hours in length and titled, “Why isn’t the evidence enough: Process management for creating a successful hospital-wide sepsis initiative,” detailed how to effectively implement a hospital-wide sepsis program; it also shared their data and success rates.

The management of sepsis in hospitals is significantly better today than it was 30 years ago. But, even so, at last estimate, only about one in eight had a such a sepsis protocol in place – even though it’s an initiative that’s not only good for patients but a facility’s bottom line.

Deadly data

Sepsis has been called a silent killer, and its statistics are shocking: In the U.S., more than 700 patients die of severe sepsis daily. It’s a leading cause of death in non-coronary ICUs. And it was the most costly reason for hospitalization in 2009, the most recent year in which data was available, topping $15.4 billion in aggregate hospital costs. Overall, it’s the 10th leading cause of death in the country.

“All across the country, this is what hospitals are dealing with,” Craig said. “Mortality is high, incidence is high and (there’s) high cost. It’s important that we incorporate the latest guidelines into our practice. There are patients that can be saved, definitely.”

CRMC went live with a sepsis protocol in the CVICU, or cardiovascular intensive care unit, ICU and emergency departments in September 2009. That same protocol went hospital-wide in October 2010. It involves screening patients that present certain symptoms and there’s a checklist to follow to see them through that process.

As a result of the changes, compared with its pre-data numbers, CRMC experienced a drop in mortality rates from sepsis, at one point seeing a 55-percent decline.

“We are doing a good job,” Craig said. “But we still need to hone in on what we can do better.”

Substantial savings

Sepsis screening is not only good for patients but protocols also have an impact on a hospital’s bottom line. According to one specific study outlined in a Critical Care Medicine journal, savings totaled $6,000 per patient and ICU costs were reduced by 35 percent. Overall hospital length of stay was also reduced by five days.
While there’s no CRMC-specific numbers, those findings fall in line with other data collected over the years.

“A lot of studies have confirmed that if you have a protocol in place, your mortality (rates) and dollars (spent) are less,” Craig said. “It’s a win-win.”

As far as the next step, Cookeville Regional is looking to share its protocol, procedures – even forms – with other health care facilities. In fact, in the weeks following the conference, multiple emails were received seeking such information. Craig also said she is especially willing to reach out across the region to share these best practices.

“Just because we are not a large metropolitan hospital does not give us an excuse to be any different than them,” she said. “We all have the same goals nationally and we should never, ever, give ourselves an excuse not to be the best. And we are paving the way to help other institutions get on board; our story was shared, we work hard and continue to do so for our patients.”

Angela Craig, APN, MS, CCNS, is a clinical nurse specialist for ICU at Cookeville Regional Medical Center. She can be reached at (931) 783-5035 or

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