Joshua Geltman, MD, MBA, Physician Chair of the Sepsis Committee at Northern Westchester Hospital

Summary

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Becker’s Healthcare Podcast

Guest: Dr. Joshua Geltman, MD, MBA, Physician Chair of the Sepsis Committee, Northern Westchester Hospital
Host: Scott Becker
Date: October 12, 2025

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Overview

This episode features Dr. Joshua Geltman, a physician leader at Northern Westchester Hospital and part of Northwell Health, discussing the challenges and advancements in managing sepsis—a life-threatening medical condition. Dr. Geltman shares insights on the prevalence of sepsis, efforts to improve outcomes, the critical role of human factors in care, and advice for aspiring healthcare leaders. The conversation also closes with lighthearted reflections on St. Louis sports fandom.

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Key Themes & Discussion Points

1. Dr. Geltman's Background and Career Path

[00:41–01:52]

• Dr. Geltman hails from St. Louis, completed undergrad at MIT, and holds an MBA with a healthcare management focus.
• Medical and postgraduate training at Northwell Health, with specialties in internal medicine, emergency medicine, and critical care.
• Progressed to roles in both the ER and ICU, now serving as full-time intensivist and head of the hospital’s Sepsis Committee.
• Emphasizes his administrative work, notably leading sepsis initiatives across the institution.

Quote:

"I'm born and bred Northwell from internship residency... now as a full time intensivist. And I wear many administrative hats. One of the most important ones for me is focusing on leading our sepsis efforts at our hospital and trying to move the needle for us and for the rest of the region." — Dr. Geltman [01:35]

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2. Understanding & Addressing Sepsis

[02:23–05:33]

• Sepsis Defined: An overwhelming and often insidious response to infection, making it difficult to recognize, unlike acute conditions like strokes or heart attacks.
• Challenges: Sepsis can escalate quickly and is often not immediately apparent to patients or clinicians until it's severe.
• Northwell’s Approach:
  • Community awareness to ensure early patient presentation.
  • Empowering frontline staff (nurses, techs, PCAs, transporters) to recognize signs of sepsis and intervene promptly.
  • Institutional focus on three pillars: early recognition, effective treatment, and timeliness.
  • Systems-level improvement, leveraging health informatics and team-based approaches for rapid action.

Quote:

"Sepsis is a tricky thing to recognize as it's developing... Healthcare is always a team-based sport, but especially with regards to sepsis in particular, taking a team-based approach is really the only way to succeed here." — Dr. Geltman [04:50]

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3. Trends and Technology in Sepsis Care

[05:45–07:53]

• Rates & Challenges: Sepsis rates are difficult to impact nationally due to its elusive nature, particularly when developed during a hospital stay.
• Focus Areas: Preventing and quickly identifying hospital-acquired sepsis is an urgent area of improvement.
• AI and Predictive Analytics:
  • Growing use of artificial intelligence and EHR-integrated risk models (e.g., Epic’s predictive tools).
  • Anticipation that AI will be pivotal for earlier detection and improved patient outcomes in sepsis.

Quote:

"...as you see AI evolving in every space, I think as it evolves in our health care space, this is going to be one of the biggest targets for AI in health care to really move the quality improvement needle for patients." — Dr. Geltman [07:36]

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4. Human Factors & Practice Innovations

[08:06–10:15]

• Empowering Staff: Emphasis on the “human element”—ensuring all staff feel equipped and authorized to act when sepsis is suspected.
• Education & Tools:
  • Enhanced training for nurses, techs, and PCAs.
  • Implementation of "code sepsis" protocols—any team member can call overhead for an immediate intervention, similar to "code blue."
  • Streamlined EHR order sets for rapid, coordinated response.
  • Benchmarking tools to measure performance and guide improvements.

Quote:

"I'm most excited about the human elements of managing sepsis... We can have all of the predictive analytics that we can purchase. However, if we don't have the frontline staff that feels empowered... we're never going to move the needle." — Dr. Geltman [08:15]

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5. Leadership Advice for Healthcare Professionals

[10:41–12:54]

• Importance of Mentorship: Dr. Geltman underscores seeking and learning from mentors as the cornerstone of his own leadership journey.
• Diversity in Guidance: Advises not to limit mentorship to those with high-ranking titles; great advice often comes from peers or professionals outside one’s own discipline.
• Career Development: Mentorship creates a “snowball effect,” facilitating further connections and opportunities.

Quote:

"I definitely would not be where I am today without the mentorship that I found early on. ...I started with my co residents, I started with the nurse manager, I started with the charge nurse." — Dr. Geltman [11:29]

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6. Lighthearted Reflections: St. Louis Sports

[13:12–15:17]

• Dr. Geltman, a lifelong St. Louis sports fan, shares a humorous and heartfelt take on the resilience and pain of rooting for local teams.
• Expresses cautious hope for the Blues and Cardinals, and jokes about the heartbreak associated with the departure of the Rams.
• Comments on building “emotional walls” as a sports fan, highlighting the camaraderie and good-natured rivalry with Chicago sports fans.

Quote:

"I would encourage him not to sign a do not resuscitate order yet. I think that there is life there to be had. I like to think of the Blues Stanley cup run as a Phoenix rising from the ashes." — Dr. Geltman [13:31]

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Notable Quotes & Timestamps

• On the Challenge of Sepsis:
  "Sepsis is a tricky thing to recognize as it's developing..." — Dr. Geltman [04:50]

• On AI’s Role in Healthcare:
  "...this is going to be one of the biggest targets for AI in health care to really move the quality improvement needle for patients." — Dr. Geltman [07:36]

• On Staff Empowerment:
  "...if we don't have the frontline staff that feels empowered to recognize sepsis and then subsequently sound the alarm...we're never going to move the needle." — Dr. Geltman [08:15]

• On Mentorship:
  "I definitely would not be where I am today without the mentorship that I found early on." — Dr. Geltman [11:29]

• On St. Louis Sports:
  "I think that analogy [Phoenix rising from the ashes] continues to serve us to this day. I think there's a lot to look forward to moving forward." — Dr. Geltman [13:34]

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Highlights & Memorable Moments

• Introduction of "code sepsis" as a rapid response mechanism
• Emphasis on multidisciplinary education and empowerment at all staff levels
• Reflections on mentorship across disciplines and career stages
• Dr. Geltman’s witty, heartfelt sentiments about the highs and lows of St. Louis sports fandom

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Episode Flow & Timestamps

• 00:00–01:52 — Introduction and Dr. Geltman’s background
• 02:23–05:33 — Understanding sepsis, challenges, and institutional approaches
• 05:45–07:53 — Sepsis trends, AI and predictive analytics
• 08:06–10:15 — Practice innovations and focusing on the human element
• 10:41–12:54 — Leadership advice and the value of mentorship
• 13:12–15:17 — St. Louis sports: humor, resilience, and rivalry

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Overall, this episode offers practical and inspirational insights into sepsis care, healthcare leadership, and a touch of sports camaraderie—underscored by Dr. Geltman's dedication to both the science and art of medicine.

Transcript

[A]

This is Scott Becker with the Becker Healthcare Podcast. We're thrilled today to be joined by a brilliant physician leader. We're joined today by Dr. Josh Geltman. Dr. Gelman is both a doctor. He also went back and did his mba. He's part of Northwell Health and he serves as the physician chair of the sepsis committee at one of their hospitals, Northern Westchester Hospital. For those that aren't familiar, Northwell Health is one of the largest health systems in the country. They're certainly the largest in New York State. They're incredibly well led with tremendous leadership. Dr. Geltman, can you take a moment and talk about yourself and your career a little bit and introduce yourself?

[B]

No problem. And thanks so much for having me, Scott. This is a really phenomenal opportunity. Happy to chat with you. A little bit about me. I originally from St. Louis, Missouri. I did my undergraduate at MIT in Boston and stuck around Boston and got a master's in biomedical science and then subsequently an MBA with a focus on nonprofit management and healthcare management. Did my medical school, my medical training at University of Missouri and then I made my way for all of my postgraduate training at Northwell. So I'm born and bred Northwell from internship residency. In my fellowship I did internal medicine, emergency medicine and critical care medicine at North Shore and lij and then made my way up to Northern Westchester Hospital after that and have been working initially both in the ER and the icu and now as a full time intensivist. And I wear many administrative hats. One of the most important ones for me is focusing on leading our sepsis efforts at our hospital and trying to move the needle for us and for the rest of the region.

[A]

And so you've had this incredible background. Both an MBA, have worked at the World Bank WashU, which is really the pride and joy academically of St. Louis. An amazing, amazing institution. You've had so many different interesting roles and also did a thesis too. I mean, fascinating. Talk a little bit about sepsis and how do we improve sepsis rates and talk a little bit about the prevalence of sepsis and what it looks like.

[B]

So sepsis is one of those nagging problems in healthcare. It's a very sticky problem. Sepsis in general, as I think people know, is in the body's sort of overwhelming response to a nasty infection, right? So it can take a normal urinary tract infection or pneumonia and then it can kind of ravage the body as the body releases all of these inflammatory cytokines that kind of makes the immune system go crazy and the patient can get very sick and die in very short order, unfortunately, if not treated, if not recognized, then treated quickly. And so this has been the challenge for healthcare systems across the country, across the world. So much so that we've created things like the Surviving Sepsis campaign. We've, on a national level at the NIH tried to come up and cms try to come up with guidelines that can help everybody survive sepsis in a way that we weren't able to in the decades prior to. And so one thing about sepsis that makes it particularly difficult to address is that it has this insidious nature, right? It kind of creeps up on people. It's not like a stroke or a heart attack. They can kind of literally smack you right in front of your face and say, oh, I've got crushing chest pain, I probably have a heart attack, I should go to the hospital. Or suddenly half my face doesn't move or my arm doesn't work anymore, I should get to the hospital, I might be having a stroke. Sepsis is a little bit more insidious. You know, you're sick, you're not feeling great, and then suddenly you start to get worse and you ultimately fall off this cliff. And so at both at home, but also in the hospital, sepsis is a tricky thing to recognize as it's developing. And so, you know, some of the things we're taking a very multifaceted approach to sepsis within Northwell and specifically within our hospital. One of which is the first part is really awareness at the community level, you know, helping folks at home understand what sepsis is and why it's important to come to the hospital and get checked out quick because it could really save lives within the hospital once they get within our four walls. It's about empowering frontline staff to recognize sepsis early. And so both so recognize sepsis early, treat it effectively and treat it in a timely manner. Those are our three buckets of sepsis management that we really try to hammer home across our institution. And so to manage sepsis is kind of a quality improvement guru's dream problem to tackle. You have to have systems level approaches creating a health care health informatics infrastructure to capture data effectively so that we can use that data, but also empowering frontline staff to raise the alarm when they think that sepsis is happening and so that we can really act quickly, quickly as a team. Healthcare is always a team based sport, but especially with regards to sepsis in particular, taking a team based approach is really the only way to succeed here.

[A]

Fantastic. What are Some of the trends you're watching in sepsis are rates of sepsis going up, down the same. Is it really challenging to try and change the trajectory of it? What are you watching on it?

[B]

So it is, you know, I mean, there's certainly up to 10% of all seven, anywhere from two and a half to 10%, depending on what metrics you're looking at, of patients that develop sepsis. And some up and some up to a quarter can develop septic shock once they're in the hospital. And so the, and those rates have been challenging to move the needle on nationally because sepsis is such again, a difficult, a difficult diagnosis to make, especially as someone, if someone isn't admitted with sepsis. So the evolving sepsis cases where you're not admitted with sepsis, but then you subsequently develop it during your hospitalization are the most challenging cases for any hospital to recognize and act on. Trends in the development of sepsis in the inpatient setting is really a big thing that most healthcare institutions are focusing on and need to focus on because those are those places where we can make a huge impact on overall mortality and morbidity if we can act quickly. I think using the biggest trend, I think in healthcare in general is AI and specifically with regards to sepsis could be a big player moving forward. Predictive analytics has been this big promise in healthcare for, as you know, for over a decade, if not longer now. And certainly healthcare records like EPIC have already developed their own predictive models to try to risk stratify these patients and identify who's going to get sicker and who's not. And I think that as you see AI evolving in every space, I think as it evolves in our health care space, this is going to be one of the biggest targets for AI in health care to really move the quality improvement needle for patients.

[A]

Fantastic. When you look at sort of making improvements, what are you most focused on and excited about currently? Sort of. Where do you see the biggest benefit coming and what are you most excited about?

[B]

So I'm most excited about the human elements of managing sepsis. I mentioned the team based sport nature of our approach to sepsis management as we've gone through all of our efforts at our hospital, and I know this is a pretty universal truth, we can have all of the predictive analytics that we can purchase. However, if we don't have the frontline staff that feels empowered to recognize sepsis and then subsequently sound the alarm and then subsequently treat things in a timely manner and make sure everything gets done as quickly as Possible we're never going to move the needle. While we've also as a hospital system involved or invested in benchmarking software to help understand where our metrics sit relative to our competitors in an apples to apples kind of way, looking at expected mortality and observed mortality. And we've been able to move the needle quite a bit on our overall mortality index, sepsis mortality index, things like that. From the thousand foot view at the five foot view at the bedside. We have invested heavily in nursing education, in our techs and our PCAs and educating them on the signs of sepsis and all the different diagnostic criteria for sepsis. We've created this code sepsis just like a code blue that you hear overhead in a hospital where someone has gone into a cardiac arrest. We created a code sepsis where a nurse or a tech or a PCA or a transporter can call a code sepsis overhead and the medical team will arrive at the bedside and start treating the patient immediately. With we've created order sets within our medical record so it make it a click of a button and all of the sepsis will orders that need to go in the labs, the antibiotics, the fluids all get ordered simultaneously to make sure that everything is being done as fast as possible. And so it's really trying to get to the source, get to the bedside and having the tools in place to support them from an EHR standpoint and from an analytic standpoint in the background.

[A]

Thank you. And talk a little bit about this, Josh. Dr. Gelman, you've had this great leadership career. You're sort of the quintessential leader. You're chief resident in your residency, you did a tremendous amount of additional research amongst a fasting number of subjects. You're clearly a lifelong learner. What advice would you give to other emerging leaders, Dr. Gelman?

[B]

Well, thanks for the question, Scott. I think that one of the things that I've always tried to circle back to is learning from the people around me. And so I've identified key people in my life as mentors every step of the way and done my best to listen to their advice as unbiased as possible. And really my career trajectory would not be what it is if not for my mentors along the way and not for the amazing advice that I've gotten along the way. I think anyone that is looking to get into a career in health care, looking to with an eye towards administrative roles in the future, trying to find effective mentorship early on can be just incredible springboard to future opportunities and to really open your Eyes to the possibilities that lay ahead. I definitely would not be where I am today without the mentorship that I found early on. And what's great is you find one mentor that you don't look for mentors necessarily that have all the titles or have all of the connections you make. Your first person, that's someone that's close to you, that you really trust, that knows you and they may have one person they can introduce you to and then the snowball effect can begin from there. So you don't have to go to the CEO the first day that you're at your institution and ask for career advice though any good CEO will take that interview and take that appointment, which ours did with me at one point. And I was very fortunate to have that. But that's not where I started. I started with my co residents, I started with the nurse manager, I started with the charge nurse. All these people that were outside of my discipline to ask for career advice because they've seen many people like me come through before me. And I've found some of the best career advice from people outside of the discipline of medicine who have been able to help guide me in my future.

[A]

Thank you very much. I'll ask you one more question. And if this is too complicated a question, Dr. Geltman, feel free not to answer. If this is too stressful or too complicated. Okay, Let me know if you're ready.

[B]

All right, Hit me.

[A]

Okay. So, so, so my brother in law is a St. Louis native and what can I tell him about the future of St. Louis sports? The Blues, the Cardinals? Where is the Future? What does St. Louis sports look like? Are you optimistic? Are you pessimistic? What do you see going forward?

[B]

You know, I would encourage him not to sign a do not resuscitate order yet I think that there is life there to be had. I mean, I like to think of the Blues Stanley cup run as a Phoenix rising from the ashes. And I think that that analogy continues to serve us to this day. I think there's a lot to look forward to moving forward. I've got. There's clearly ownership that's not going to desert us like Stan Kroenke did with the Rams, which was crushing as a region. And I think no one's buying him a beer anytime soon. I think that I feel heartened knowing that Chicagoans like yourself will soon enough be in tears again, even though it may not be this season, but, you know, maybe it's coming for sure.

[A]

Well, it's been a long time since we've had great success in Chicago. My brother in law still cheers for the Arizona Cardinals. Do you cheer for the Arizona Cardinals or is that, is that. No, He's a diehard St. Louis fan and follows them. Where's your head at on that?

[B]

You know, I think, you know, I've just been hurt too many times. You know, I've become a student of the game, Scott. I think when that, when it comes to football, I think I've had to, to build up a little emotional wall. You know, I think that the, even when we still had the old Bush Stadium, it wasn't good enough for the, for the Cardinals. We had the, you know, our current stadium, which wasn't good enough for the Rams. You know, I'm okay with rooting for, you know, people outside the region and I just want to see a good game at this point. I'm afraid, I'm afraid of being hurt again.

[A]

I hear you. I feel you're hurt. I always love the rivalry with the bl, with the Cardinals. It's Chicago Blackhawks and, and, and Cubs fans. So it is what it is. We wish you luck. We don't cheer against the St. Louis teams. We cheer for them unless they're playing the Cubs or Chicago teams. Thank you for. Josh, thank you so much for joining us today. Just fantastic. Thank you very, very much, truly.

[B]

My pleasure, Scott. Thanks. Have a great day.