The United States has a long and proud tradition of taking care of those who serve in our armed forces. The Department of Veterans Affairs traces its mission back hundreds of years, beginning with the Continental Congress providing pensions to disabled soldiers. Since its formal creation in 1930, the VA, specifically the Veterans Health Administration, has grown into one of the largest health care organizations in the country, tasked with providing the highest quality of care to millions of our nation’s veterans with the latest health care technology available.
Since my retirement, I have been actively involved in advocating for and ensuring continuing quality care to all members of our military family including active-duty personnel, dependents and veterans. Having spent many years in this world, a frustrating challenge that I continue to see is the “acceptance” of certain inferior health outcomes associated with preventable medical and diagnostic error. As a physician and longtime military leader, I find this unacceptable. I believe it’s our duty to do all in our power to advance the “standard of care” with new technologies, techniques and procedures. We should always, always, strive to improve the standard of care, not simply accept it.
Delivering the best patient care possible is only achievable through proper diagnosis. In the United States, over 70% of all patient treatment decisions are based on laboratory test results, but in certain instances, these results can be inaccurate and/or misleading. A prime example is sepsis, a life-threatening immune reaction triggered by a severe bloodstream infection. While patients with a mild case of sepsis typically recover, in severe cases, including septic shock, an estimated 40% of patients do not survive. According to the CDC, sepsis claims the life of an estimated 270,000 Americans each year. As a comparison, COVID-19 has a 1.8% mortality rate — over twentyfold lower than sepsis.
The challenge with diagnosing sepsis is that standard of care blood test is frequently wrong. Each year, more than 20 million Americans demonstrate symptoms of sepsis and are tested in U.S. hospitals. Of those tests that return for a positive result for bloodstream infection including sepsis, an average of 40% of positive results are false positive. These false positive results drive the improper use of powerful antibiotics, which contributes directly to antimicrobial resistance, avoidable hospital admissions and length of patient stay — all of which unnecessarily increase strain on an already overworked health care system. Within the VHA, it’s estimated that nearly 30,000 patients are affected by false-positive blood cultures annually, with more than $125 million unnecessarily spent by the VHA each year on inappropriate and avoidable treatment associated with false positive sepsis test results.
Based on advances in technology and new clinically proven performance thresholds, it is time to reset the standard for sepsis testing accuracy and blood culture contamination rates. Today’s standard of “acceptable false positive results” of 3% or below does not represent the best practice performance level we must hold ourselves accountable to achieving. The new target performance threshold we must implement is less than 1% false positive results for sepsis testing across the entire VHA system.
We know this performance level is possible because the VHA has effectively implemented this new standard of care in over a dozen medical centers across the country, achieving unprecedented results. In 2018 for example, the Houston VA Medical Center reported an astounding 83% reduction in blood culture contamination and false positive results with the use of new and readily available medical device technology. The VA North Texas Health System in Dallas achieved similar results with a 68% reported reduction in false positive sepsis tests.
While this data demonstrating dramatic reductions in false positive sepsis tests gives us reason to celebrate, it’s unconscionable that the quality of care a veteran receives is subject to chance based on where they live, and thankfully it seems Congress finally got the message. Just last month, a congressional subcommittee responsible for funding the VHA directed the VA to “prioritize the development of a specific quality measure for blood contamination based on the recommendation of less than 1% blood culture contamination rate within 6 months of enactment.”
Now we all need to work together to ensure each and every VA medical center executes on this directive. Every U.S. veteran deserves access to the best technologies to support their health, safety and well-being. In the case of accurate sepsis testing, the outcome benefits everyone.
Bill McDaniel, a physician, is a retired U.S. Navy rear admiral. He sits on the Medical and Scientific Advisory Board of Magnolia Medical Technologies, which manufactures a device that is used — in VA centers and elsewhere — when blood is drawn to reduce the instances of false positive.
