Philly hospital uses ‘escape room’ to take the mystery out of sepsis

A group of doctors and nurses at Penn Presbyterian Medical Center in Philadelphia is huddled around Sam, a 50-year-old, die-hard Eagles fan.

Sam fell from a lamp post while celebrating the Eagles’ Super Bowl win and cut his right calf. Now, Sam has taken a turn for the worse.

Only, Sam isn’t real. He’s a dummy lying on a hospital bed in a training room. The medical team is using him as part of an exercise to learn how to spot and treat sepsis, a potentially fatal complication from infection.

The space is set up like an “escape room,” with riddles and clues, which the team must solve in order to get out of the room and save Sam.

The idea is to highlight the threat sepsis poses — and to put the condition at the front of practitioners’ minds.

“People aren’t as familiar with the signs and symptoms of sepsis as they are with heart attacks and strokes,” said Casey Lieb, clinical nurse educator at Penn Presbyterian. “So we found there was an educational gap there that we could really fill with this.”

When you get an infection, your immune systems kicks into gear to fight off whatever germs have invaded your system. But sometimes, for reasons researchers don’t entirely understand, your immune system stops fighting the invaders and turns on itself, attacking tissue in the lungs, kidneys, and other vital organs.

That process of sepsis is the leading cause of hospital deaths, with approximately 270,000 people succumbing to the condition every year. It can stem from any number of common infections, from a urinary tract infection to a skin infection such as cellulitis.

Doctors look for four major signs in diagnosing sepsis: higher or lower than normal temperature; signs of infection; mental confusion or sleepiness; and severe pain or discomfort.

The key is for doctors and nurses to identify those signs early enough, so that the patient doesn’t go into septic shock, when blood pressure drops to dangerous levels.

Patients should also be aware of the signs of sepsis, but a recent survey by the Sepsis Alliance found that only 12 percent of those surveyed could correctly identify all four signs, whereas 25 percent could identify all four signs of stroke, which is half as common as sepsis and kills half the number of people each year.

“It’s really a huge crisis that is underrespected and underreported,” said Tom Heymann, executive director of the Sepsis Alliance. “Early suspicion leading to early treatment is the key.”

A personal experience

Staff nurse Lauren McPeake, who helped organize the Penn Presbyterian training, knows about sepsis first hand. Six months ago, while in labor with her first child, she developed sepsis from a uterine infection.

“It was really, really scary,” she said. “I was very anxious. I felt like the walls were closing in on me. I felt like I was going to die.”

The doctors recognized her symptoms immediately — a high temperature, intense shaking, disorientation. They treated her with antibiotics, and she and her baby survived.

That isn’t always the outcome. Sepsis accounts for about half the deaths at hospitals across the country. It’s also expensive to treat. According to the Sepsis Alliance, the condition cost hospitals about $18,000 per patient in 2014.

But it can be reversed if it’s caught early, as it was in McPeake’s case. That’s why Penn Presbyterian and health systems around the country have started putting an emphasis on training staff to recognize the symptoms.

“Our goal is to bring sepsis to the front of everybody’s mind,” said Sean Foster, emergency physician at Penn Presbyterian and the University of Pennsylvania.

“We hope that people will start to ask that question earlier in the patient’s course, to start looking earlier for some of the signs that the patient could be septic, and at the earliest possible time start initiating those therapies that will lower the chance that that patient has a bad outcome,” he said.

McPeake said creating this training as a sepsis survivor herself has given her a new perspective on her work.

“It really made me understand what my patients go through when I do care for a patient that does have sepsis,” she said.