The Current - How is Nova Scotia revolutionizing their sepsis approach

Episode Date: September 25, 2025

In the last year, Nova Scotia Health implemented a sepsis action improvement plan in six health care facilities throughout the province. It's worked so well, now, they're rolling it out province wide. In a first for Canada, all ER nurses across Nova Scotia will be able to administer antibiotics to anyone they suspect of having sepsis by the end of the month — a move that advocates are saying can, and will, save lives. We speak to Dr. Vanessa Sweet -- the medical co-lead of NHS' sepsis action improvement plan — about how Nova Scotia is changing how they approach sepsis, and what other provinces can learn from the work they're doing.

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This past June, his wife, Ravinder, delivered their third baby. She developed an infection in hospital, and days later, died of sepsis. She fought with this infection for four days, almost two and a half days without any help. And imagine that if the help would have arrived sooner, she was such a fighter that she would have the best chance of survivability and she could have made it. Sepsis happens when your body's response to infection becomes so severe that it damages vital organs and often causes death.

Garinder says the signs of sepsis were ignored by the hospital until it was too late and that his wife's death could have been prevented if antibiotics were administered to her in time. It's very hard to raise a baby without the mother's soul. Multiple lives are involved. So I really hope that this will bring the change to our medical system. So I really hope that no other mother has to go through this,

what my wife has to go through. How many more mothers have to die before we act? Grendersidu is now one of many people calling for Canada to develop a national sepsis strategy. It is estimated that sepsis causes one in 18 deaths in this country, and time is key with sepsis, identifying it and treating it quickly saves lives. In Nova Scotia, a new project is doing just that with their sepsis action improvement team. And what's being called a Canadian first, part of that plan allows nurses to administer antibiotics to anyone suspected of having sepsis.

Dr. Vanessa Sweet is an anesthesiologist and the medical co-leet for Nova Scotia Health's sepsis action improvement team. She is in Halifax. Dr. Sweet, good morning. Good morning. I want to get to what you are doing in a moment, but why, as you understand it,

has delivering quick treatment for sepsis been so difficult and passed? That's a really good question, and it seems so obvious, right? But when we look at a combination of things, both the pressures that the health care system is facing right now and the fact that sepsis can present in so many different ways, it gets hard to close that gap between recognition and action, and things have to be really tightly connected. You know, we have great mental images of other urgent things like heart attacks and strokes, and we don't have the same for sepsis. And we didn't have processes in place to help people do the right thing and to make it easy to do the right thing before now. We know that, I mean, that's earlier, it's something like 18,000 people across this country die every year because of sepsis. And we know that many of those deaths are preventable if antibiotics are given in time. Why is that so important time when it comes to treating sepsis?

Yeah, and time is of the essence with this. And like you said, sepsis is that sort of overwhelming response to an infection. And so really the key is treating the infection, getting control of the source and getting antibiotics in. We know that every additional hour that patients have to wait to get antibiotics materially increases their mortality from sepsis. When we spoke about this, with Garinda, at the end of the conversation, what we learned is that in some ways this is a

solvable issue. You can actually deal with this. And so what is Nova Scotia done? What is the plan in that province to treat sepsis? Yeah. So it's been a bit of an enigma for a while, and we're not the only ones to have struggled with how we address sepsis. What we did was in January 2024, struck this action improvement team to take a radically different approach to how we understood the problem and understood the barriers to providing the care that we know we want to provide for patients. So we focused on emergency departments in particular. We know that a huge proportion of our sepsis cases actually present from the community to our emergency departments.

And what we did was worked hand in hand with our frontline health care teams, our doctors, our nurses, our paramedics, and importantly our patient and care partners to really understand what they need to be able to provide the right care to the right patient at the right time. And so co-designed solutions with them. So those frontline staff and patient and family advisors built the tools that went into what it was ultimately our sepsis improvement package that has a whole bunch of things

ranging from sepsis kits, measurement plan, and indicators. We've got micro-learning, sepsis champions, patient-oriented, discharge summaries and information. We have the care directive that you spoke to that allows nurses and paramedics to initiate antibiotics for patients who screen positive for sepsis presenting to emergency departments. And we've got, you know, order sets for docs to make it easy to continue the treatment that our nurses and paramedics have initiated. So it's really the whole package with support around it for improvement coaching and weekly huddles to help the frontline teams keep the cadence of the good work that they're doing. With the understanding, as you said, that time, this is all about time in many ways. Absolutely.

Yeah. Time is obvious. Can I ask you with the nurses part of this? Because when I spoke with Grendersidu, he asked why, having gone through the horror that his family went through, he asked why, at least in the province of Ontario where he is, nurses don't have the power to administer antibiotics. I mean, I'm not a doctor. But you said earlier, in some ways that solving something like this seems obvious. Why haven't nurses been able to administer antibiotics in the past? Because we haven't made it a priority to make them able to do that.

We've allowed our nurses and enabled nurses and paramedics to do that in other life-threatening situations. So, you know, we have medical directives in place to let them administer epinephrine in cases of anaphylaxis and things like that. And so really, when we were doing this work, we identified that this was a huge gap in terms of allowing, these incredibly brilliant and skilled health care providers to work to their full scope of practice. They're seeing the patients. They're the first ones to recognize this. And so why not enable them to do that with appropriate safeguards and inclusion and exclusion criteria and contingency plans and education and all the rest? But it's good for health care providers and good for patients when all of our team members can work to their full scope of practice.

I guess I'm still trying to figure out why that wouldn't be happening in past. I mean, is that about territory? Is it about, I mean, I just, if that is possible in other areas, as you said, anaphylaxis, where time is also of the essence, what was the resistance here? Do you know? We didn't honestly find a whole lot of resistance. I think the bigger thing is that in eras past, we didn't have health care systems that had so many tightly linked contingencies, right, in, in, in, in, in, in,

has gone by, you could walk into an emergency department and see a prescriber within an hour or two, which is, you know, which is great, but not the reality that we're in right now. Because the system is stretched and doctors are in different places. Yeah. And so this just took a critical eye to identify where the gaps are and a willingness to say, how might we? One of the parts of this is allowing, you know, those nurses to do this, but allowing them to do it with a sense that that time is at the center of this conversation. And I wanted to hear from one of those nurses.

Kayla Dort is a registered nurse in the ER at Cobbockoid Community Health Center in Nova Scotia. She's one of the programs, sepsis champions. You mentioned them earlier. Have a listen to what she says about this. Having the ability to be like, you know, we see what's going on. We're actually going to start some antibiotics right now.

The reaction from them is, it's so humbling because they're like, oh, my gosh, you can do that. You can start this right now. This is so amazing. We know that's what they need. They really feel like they're hurt. And physicians, you know, sometimes they're rushing to come and they're like, let's do this, this and this. And we can say, you know what?

We already did that. And we started that. And they're like, it's like a relief off of them as well. We're a very busy department. And we do see a lot of people that are really, really ill. And our ability to act fast has really changed the outcome for those patients. She says it's changed the outcome for those patients. What have you seen in terms of the outcome for sepsis patients in Nova Scotia?

Yeah, so one of the key things that we've been tracking is what we're calling our door to antibiotic time. So how long does it take when you come into an emergency department presenting with signs and symptoms of sepsis to get your first dose of antibiotics? And what we know from our own local data is that before this initiative, only about half of our patients who presented to our emergency departments with signs and symptoms of sepsis, we're getting their antibiotics within the target time. And that's three hours, right? Yeah, yeah. There are some subtleties to that, but in general, three hours. And so through this work, what we've been able to do is get more than 80% of our patients

having their antibiotics within three hours with an average time of about 124 minutes right now. And so this is across all of the sites that we've been doing this, which include some rural sites that don't actually have prescribers on site on a consistent basis. So this is a game changer for sepsis care in Nova Scotia. That's saved lives. Yeah, yeah. And we know that every hour that we get our treatment in and get the antibiotics started does change outcomes. So, you know, if it's not a life saved, it's perhaps an ICU stay prevented or perhaps an ICU stay shortened or perhaps a hospital admission avoided or shortened.

So the downstream system impacts are huge. This is right now in place in a handful of hospitals in Nova Scotia, but you are expanding it across the province next month? We are. So we've started the provincial rollout earlier this month. We began with three and then six sites around the Halifax area. And by the end of October, the plan is that this will be implemented in every emergency department and urgent treatment center in Nova Scotia. So go back to that solvable piece. If 18,000 people or so are dying of sepsis across this country, every year. How difficult would it be for other provinces to follow suit? How difficult would it be to roll this out across the country? I'm a huge advocate of shamelessly taking other people's brilliant ideas with credit, of course, and doing that wherever we can. Sepsis is complex, and I

don't think that our work, as exciting as it is, is a silver bullet. There are things to consider with in-hospital sepsis, but I think there's a lot that could translate really nicely to emergency departments across the country. And I think the biggest thing that translates is our approach. And I think that that can go anywhere and everywhere. Medicine is personal. I mean, you are speaking about this as an expert, but you are also speaking about people. Who do you think about when you do this work in terms of changing how sepsis is treated in your province? Who comes to mind? There are so many people who come to mind. I wish it weren't as easy as it is to pull, you know, people like Rivinder to mind. We had the

honor of working with a fabulous patient and family advisor, Mark, whose late wife, Diana, was impacted by sepsis. I've had sepsis in my own family. So you think about the patients. You also think about the staff and what this means to lower the moral injury that health care providers are facing when they see what needs to be done. But there are barriers that prevent them from doing it. So, you know, the joy of the nurses and paramedics being able to work to their full scope of practice, the relief of the physicians that they're not behind the eight ball when they're finally seeing a patient who came in with sepsis, it's rewarding from start to finish. Every person this touches. It matters to me. I hope other provinces steal your idea with credit.

I hope so too. Dr. Sweet, it's good to talk to you. Thank you very much. Thank you so much. Dr. Vanessa Sweet is the medical co-lead for Nova Scotia. health sepsis action improvement team. She was in Halifax. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca slash podcasts.