Before and after standardizing the controversial sepsis resuscitation bundle in a large hybrid academic center

Ferreira, Tanira; Diaz, Yvonne; Beg, Rana; Wawrzyniak, Andrew J.; Brito, Yoel; Burik, Yaroslav; Falise, Joseph; Abbo, Lilian M.; Ashley, Doreen; Lang, David M.; Mendes, Eliana S.; Lupe, Lori; Sneij, Waleed

doi:10.21037/jeccm.2017.08.05

Cited by 2 publications

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“…14 Although there remains significant debate regarding the optimal approach to standardizing practices that promote the early diagnosis and treatment of sepsis to save lives, consistent application of the SEP-1 bundle has been shown to be an effective method for doing so and remains a CMS core quality measure. 4,[15][16][17][18][19][20][21] The management of patients with sepsis also is among the most costly medical treatments reimbursed by Medicare, representing 8.2% of all Medicare inpatient hospital costs at an estimated $15 billion annually. 22 In addition to the financial costs associated with acute inpatient hospitalization, long-term physical, psychological, and cognitive sequelae often require admission to long-term care facilities.…”

Section: Discussionmentioning

confidence: 99%

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay

et al. 2021

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This retrospective, cross-sectional study of U.S. hospitals in Medicare's Inpatient Quality Reporting Program aimed to determine whether variation in Sepsis/Septic Shock (Bundle SEP-1) compliance is linked to hospital size and measures of safety and operational efficiency. Two thousand six hundred and fifty-three acute care hospitals in Medicare's Hospital Compare online database were included in the study. Relationships between SEP-1 bundle compliance, hospital size, and indices of operational excellence (including Patient Safety Index [PSI-90], average length of stay [ALOS] and readmission rate) were analyzed. SEP-1 compliance score was inversely associated with staffed bed number (r = −.14, p < .001), PSI-90 (r = −.01, p < .001), and ALOS (r = −.13, p < .001) in a multivariate analysis. Hospitals in the lowest versus highest quartile by bed number had SEP-1 compliance score of 49.8 ± 20.2% versus 46.9 ± 16.8%, p < .001. Hospitals in the lowest versus highest quartile for SEP-1 score had an ALOS of 5.0 ± 1.2 days versus 4.7 ± 1.1 days and PSI-90 rate of 1.03 ± 0.22 versus 0.98 ± 0.16, p < .001 for both. Although this does not establish a causal relationship, it supports the hypothesis that the ability of hospitals to successfully implement SEP-1 is associated with superior performance in key measures of operational excellence.

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Section: Discussionmentioning

confidence: 99%

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay

et al. 2021

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“…Although randomization to performing or not performing a follow-up lactate in patients presenting with intermediate lactate concentrations, such studies would be challenging since retesting is currently considered a standard of care. Second, the studied hospital has a well-established sepsis care protocol with high adherence, based on the surviving sepsis campaign guidelines [ 27 ]. Consequently, its sepsis-related mortality is lower than the overall average estimated from the most recent epidemiologic data [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Failure to Clear Intermediate Lactate Levels in Ward Patients With Admission Blood Cultures Did Not Increase the Risk of Intensive Care Unit Transfer or In-Hospital Mortality: A Retrospective Cohort Study

Dudaryk¹,

Navas-Blanco²,

Ferreira³

et al. 2021

Cureus

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Introduction A sepsis bundle instituted by the Centers for Medicare and Medicaid Services, known as SEP-1, mandates remeasuring lactate concentrations in patients with suspected sepsis who have an initial lactate level ≥ 2.0 mmol/L to identify those at risk of mortality or clinical deterioration. However, in the group with an intermediate lactate level (2.0-3.9 mmol/L), evidence for the predictive utility for such practice is lacking. The objective of this retrospective cohort study was to evaluate the potential utility of repeating the blood lactate measurement for the premonitory detection of clinical deterioration in patients admitted to a ward with a diagnosis of suspected sepsis and an initial intermediate lactate level. Methods Using electronic health records, we retrospectively evaluated all non-hospice adult patients admitted from the emergency department to a ward of an academic medical center between October 1, 2017, and November 30, 2019, in whom a blood culture was obtained on admission as part of their workup for suspected sepsis. Patient demographics, the times and values of lactate concentrations, the occurrence of subsequent intensive care unit (ICU) transfer during the admission, and hospital mortality were determined. We computed the relative risk of ICU transfer (i.e., clinical deterioration) and hospital mortality in patients whose initial lactate was in the intermediate range who failed to reduce their lactate concentration by at least 10% within six hours. We hypothesized that failure to clear the lactate would be associated with an increased risk of ICU transfer and hospital mortality. Results We studied 12,157 patients, of whom 25 hospice patients were excluded. Of the remaining 12,132 patients, 1,416 (11.7%) were initially admitted to an intensive care unit, and 10,716 (88.3%) were admitted to a ward. Repeat lactate determinations were performed in 10.7%, 77.1%, and 90.2% of the ward patients with initial normal (< 2.0 mmol/L), intermediate (2.0-3.99 mmol/L), and high (≥ 4.0 mmol/L) admission lactate concentrations, respectively. There was no increase in the relative risk of ICU transfer (relative risk [RR] = 0.90, 95% CI, 0.53-1.28, P = 0.55) or hospital mortality (RR = 1.23, 95% CI, 0.85-1.79, P = 0.27) within the intermediate lactate level group among those whose lactate remained within 10% of the initial value (i.e., no change) or increased by more than 10%, compared to those in whom the level decreased by more than 10%. Conclusions Failure to reduce lactate concentrations in ward patients admitted with possible sepsis and an intermediate lactate level was not associated with an increased risk of ICU transfer or mortality. These results call into question the mandate in SEP-1 to routinely repeat the lactate determination in patients presenting with an intermediate concentration.

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Before and after standardizing the controversial sepsis resuscitation bundle in a large hybrid academic center

Cited by 2 publications

References 0 publications

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay

Failure to Clear Intermediate Lactate Levels in Ward Patients With Admission Blood Cultures Did Not Increase the Risk of Intensive Care Unit Transfer or In-Hospital Mortality: A Retrospective Cohort Study

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