Improved Protocols for Early Sepsis Recognition and Treatment in Rhode Island

From Darkness Comes New Light on Sepsis

Rhode Island lawmakers recently passed a milestone law that improves protocols for early recognition and treatment of sepsis across the state. 

The new law emerges from the efforts of three Rhode Island families who each lost a child to sepsis and subsequently channeled their despair into hope. Working with a Lifespan physician and their elected officials, these families succeeded in establishing a potentially lifesaving law that will prevent many more Rhode Islanders from the heartache they experienced. 
 

Following New York’s Lead

Lee A. Polikoff, MD, a pediatric intensivist with Hasbro Children’s Hospital and an associate professor of pediatrics at The Warren Alpert Medical School of Brown University, worked closely with the families of Layla Charette of Cumberland, who died in 2017, Emily Otrando of Cumberland, who died in 2014, and Gianna Cirella of Warwick, who died in 2017. Both Layla and Gianna were his patients. 

When Gianna’s mother, Tara, approached Dr. Polikoff seeking help in finding a positive direction from her personal darkness, he suggested she emulate what the New York family of Rory Staunton had accomplished more than a decade ago. After their 12-year-old son Rory died from undiagnosed and untreated sepsis, they rallied to raise awareness of sepsis and to improve procedures in emergency rooms. Their efforts established “Rory’s Regulations,” a set of regulations implemented in New York State to improve the rapid diagnosis and treatment of sepsis. They require every hospital in the state to develop protocols designed to improve rapid identification and treatment of sepsis and be approved by the New York Department of Health.

Rhode Island’s New Law

In Rhode Island, Dr. Polikoff and the families advocated for change over the course of five years, which included the disruption from the pandemic. They testified before and negotiated with health and human safety sub-committees in both the House and Senate to pass a bill.

In January, 2023, Rhode Island Governor Dan McKee signed into law 2023-S 0283A, 2023-H 5869A, requiring the director of the Department of Health to develop in coordination with the Antimicrobial Stewardship and Environmental Cleaning Task Force information on best practices for the treatment of patients with sepsis and septic shock. Each hospital and freestanding emergency-care facility is now required to implement procedures and policies in accordance with this information.

“This is a significant achievement for patient advocacy throughout Rhode Island,” Dr. Polikoff said. “It demonstrates the dyad between the state and its healthcare systems. It is truly a testament to the tenacity of the families who worked diligently to make these changes.”

Presently, Hasbro Children’s Hospital's emergency medicine department and ICU are participating in an international pediatric fluid resuscitation clinical research study evaluating the comparison of normal saline and balanced fluids solutions in children with evidence of septic shock. The study is sponsored by the National Institutes of Health and Children’s Hospital of Philadelphia, and administered through the Pediatric Emergency Care Research Network (PECARN).