In the U.S. alone, 1.7 million adults are hospitalized with sepsis each year, leading to approximately 350,000 deaths. Sepsis, an immune response to an injury or infection, can lead to tissue damage or organ failure. Sepsis is a leading cause of hospital admissions and can occur unpredictably and progress rapidly – even in healthy people — which is why early detection is paramount to a patient’s survival.

HCA Healthcare hospitals began using Sepsis Prediction and Optimization of Therapy (SPOT) in 2018. The tool uses rules-based algorithms focused on patient vital signs, labs, nursing reports and other data to help identify sepsis approximately six hours earlier than traditional screening methods. Identifying sepsis early is critical to saving lives, and HCA Healthcare was recognized by The Joint Commission and the National Quality Forum with the 2019 John M. Eisenberg Patient Safety and Quality Award at the national level for its work with SPOT to help reduce sepsis mortality, as well as the 2019 Red Hat Innovation Awards winner.

While SPOT was initially developed to identify sepsis more quickly,
HCA Healthcare continues to raise the bar by expanding its capabilities. Our data scientists are developing upgrades that can improve patient monitoring through continuous deterioration models – a process that models and predicts physical condition preemptively, which could lead to more personalized treatment plans. In addition, mobile integration means care teams can receive faster alerts through their mobile devices.

Jeffrey Guy, MD, and vice president of HCA Healthcare’s Care Process Design, Clinical Services Group, says that ongoing research helps clinicians make better patient treatment decisions, including adjusting how antibiotics are prescribed. Through large-scale collaborations focused on sepsis epidemiology, surveillance, diagnosis and care, HCA Healthcare is transforming how sepsis is studied, tracked and treated. Our partnership with Harvard Pilgrim Health Care Institute has produced landmark research that is shaping national policy and clinical practice.

“We’re trying to fine-tune how patients get treated,” Dr. Guy says. “It’s really taking SPOT from a qualitative signal to a more quantitative one and getting the patient the right level of care.”

The collaborative efforts between data science, engineering teams, clinicians and external research partners inform HCA Healthcare’s approach to improving sepsis care management across the enterprise and beyond.

Most cases of sepsis are caused by bacterial infections. Traumatic injuries and viral infections such as COVID-19 or influenza can also result in sepsis. It is the third leading cause of death in U.S. hospitals, and those who are critically ill are at even greater risk. However, sepsis can be preventable or treatable if addressed in time. For every hour of a delayed sepsis diagnosis, the chance of death increases between 4% and 7%.

The introduction of SPOT in 2018 had HCA Healthcare clinicians ahead of the curve when it came to sepsis readiness when faced with COVID-19. Before the development of SPOT, screening for sepsis was entirely manual and taking place as nurses changed shifts or made rounds. The original iteration of SPOT works in real time with the help of hospital servers, which consistently ingest thousands of patient data points. The computers collect clinical data throughout a patient’s hospitalization and, if a pattern of data consistent with sepsis occurs, it signals an alert to trained telemetry technicians. These technicians serve as a critical communication bridge, accelerating notification to bedside clinicians.

In 2024, the migration of SPOT from the HCA Healthcare data center to an entirely cloud-based system enabled the tool to expand its scale to more hospitals. The migration also enabled SPOT to run without maintenance-related downtime for nearly a year.

The adoption of SPOT has significantly reduced the time from alert to clinical action, which has been associated with improved sepsis outcomes and earlier interventions across our hospitals, and has established the groundwork for evolving sepsis care practices nation-wide.

One pivotal study — conducted in collaboration with the Centers for Disease Control and Prevention (CDC) and published in JAMA (the Journal of the American Medical Association) in 2017 — provided the CDC’s official estimates of the national burden of sepsis and changed how the condition is monitored by hospitals, researchers and public health agencies.

The study demonstrated that clinical data extracted from electronic health records (EHRs), including blood culture orders, antibiotic administration and markers of organ dysfunction, provide a more accurate method for identifying sepsis than relying on billing codes. The study drew upon hundreds of hospitals across seven large networks, for which HCA Healthcare contributed the largest and most comprehensive dataset. The methods developed from this research now underpin the CDC’s Adult Sepsis Event toolkit, which has become the national standard for sepsis surveillance.

“HCA Healthcare was an essential partner in this important work,” says Chanu Rhee, MD, MPH, director of the Center for Sepsis Epidemiology and Prevention Studies (SEPSIS) at the Harvard Pilgrim Health Care Institute and associate professor of population medicine at Harvard Medical School. “Their clinical data warehouse is extraordinarily well curated, with rigorous data quality controls, and was the backbone of our study.”

The partnership continues to thrive. Dr. Rhee and HCA Healthcare collaborators have led several follow-up studies, including analyses of sepsis in previously healthy individuals and in people with opioid use disorders — offering critical insights into underexplored populations.

Most recently, Dr. Rhee and the HCA Healthcare team received the Gold Medal STAR Research Award at the 2025 Society of Critical Care Medicine Conference for their study on the relationship between time-to-antibiotics and mortality in sepsis — the largest and most comprehensive study to date on this topic. Using HCA Healthcare’s extensive data warehouse, the researchers identified key physiologic markers that signal when immediate antibiotic treatment is necessary. The findings are expected to help clinicians and regulators better target patients who require urgent care, reduce unnecessary antibiotic use and simplify metrics for evaluating timely sepsis care.

Ongoing sepsis research includes CDC-funded projects to develop a national risk-adjusted sepsis mortality quality measure, and to develop an EHR-based surveillance definition for pediatric sepsis to be applied across HCA Healthcare and several other large healthcare systems to estimate the national burden of sepsis in children. In parallel, another study will lay the groundwork for a new metric for hospital-onset sepsis, designed to identify the most serious healthcare-associated infections and drive quality improvement efforts for hospitalized patients.

Dr. Rhee underscores the value of the Harvard-HCA Healthcare collaboration, saying, “HCA Healthcare’s scale and sophisticated data infrastructure enable us to conduct high-impact epidemiologic research that would be difficult to do anywhere else. Their network of primarily community-based hospitals also provides a more diverse and generalizable patient population than most studies that typically focus on academic hospitals alone.”

“We’re deeply grateful for our longstanding partnership with HCA Healthcare,” he adds. “Together, we are able to study the details of sepsis care and conduct research and interventions at a scale unmatched anywhere else.”

The next iteration of SPOT has shifted the focus beyond a sepsis diagnosis to more personalization. SPOT 2.0 could assess a person’s current health with other factors such as age, illness (or reason for hospitalization) and other medical conditions. For example, patients in ICUs tend to meet sepsis criteria because of the severity of their medical condition, and SPOT is getting fine-tuned to identify not only the present risk, but the acuity of needed care.

Derek Schatzlein, director of software engineering for HCA Healthcare’s Accelerated Technologies, explains that symptoms such as increased heart rate, abnormal breathing or white blood count could all indicate sepsis.

“There’s a difference between someone who’s perfectly healthy and becomes septic versus someone who’s already in the ICU and has gotten considerably sicker,” Derek says. “As humans, it’s hard to see that signal through the noise, but we can figure that out with the proper analytics and data science.”

Data scientists are also reviewing HCA Healthcare’s history of SPOT detections, as well as new clinical signals to determine the appropriate combination of scores that have the highest predictive value. The value of those scores could determine the level of care a patient might need in real time.

The goal is to use continuous monitoring to identify the rate of change in a patient and whether they are getting worse or better. Research and input from clinical teams are guiding these SPOT improvements.

“Our team of engineers remain engaged because we’ve had such strong support from all pillars,” Derek adds. “I can’t praise Dr. Guy enough for doing it the right way, involving all the right research folks and physicians and starting from there rather than just going off and trying to build the next great app.”

“HCA Healthcare was an essential partner in this important work,” says Chanu Rhee, MD, MPH, director of the Center for Sepsis Epidemiology and Prevention Studies (SEPSIS) at the Harvard Pilgrim Health Care Institute and associate professor of population medicine at Harvard Medical School. “Their clinical data warehouse is extraordinarily well curated, with rigorous data quality controls, and was the backbone of our study.”

The partnership continues to thrive. Dr. Rhee and
HCA Healthcare collaborators have led several follow-up studies, including analyses of sepsis in previously healthy individuals and in people with opioid use disorders — offering critical insights into underexplored populations.

Most recently, Dr. Rhee and the HCA Healthcare team received the Gold Medal STAR Research Award at the 2025 Society of Critical Care Medicine Conference for their study on the relationship between time-to-antibiotics and mortality in sepsis — the largest and most comprehensive study to date on this topic. Using HCA Healthcare’s extensive data warehouse, the researchers identified key physiologic markers that signal when immediate antibiotic treatment is necessary. The findings are expected to help clinicians and regulators better target patients who require urgent care, reduce unnecessary antibiotic use and simplify metrics for evaluating timely sepsis care.

Ongoing sepsis research includes CDC-funded projects to develop a national risk-adjusted sepsis mortality quality measure and to develop an EHR-based surveillance definition for pediatric sepsis to be applied across HCA Healthcare and several other large healthcare systems to estimate the national burden of sepsis in children. In parallel, another study will lay the groundwork for a new metric for hospital-onset sepsis, designed to identify the most serious healthcare-associated infections and drive quality improvement efforts for hospitalized patients.

Dr. Rhee underscores the value of the Harvard-HCA Healthcare collaboration, saying, “HCA Healthcare’s scale and sophisticated data infrastructure enable us to conduct high-impact epidemiologic research that would be difficult to do anywhere else. Their network of primarily community-based hospitals also provides a more diverse and generalizable patient population than most studies that typically focus on academic hospitals alone.”

“We’re deeply grateful for our longstanding partnership with
HCA Healthcare,” he adds. “Together, we are able to study the details of sepsis care and conduct research and interventions at a scale unmatched anywhere else.”