Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED

Whitfield, Philip L; Ratliff, Patrick D.; Lockhart, Lisa L.; Andrews, Dan; Komyathy, Kelsey L.; Sloan, Mark A.; Leslie, Jeremy C.; Judd, William R.

doi:10.1016/j.ajem.2019.07.002

Cited by 17 publications

(20 citation statements)

References 12 publications

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“…In the years since the establishment of the SSC in 2002, there have been many changes in the management of sepsis, including the implementation of simplified and standardized therapeutic strategies, and comprehensive management may help reduce the marginal benefit related to the expertise of experienced clinicians and subspecialty care providers [ 21 , 22 ]. Most participating institutions in the present study have applied the “Code Sepsis” protocol based on recommendations from the international guidelines and national healthcare authorities.…”

Section: Discussionmentioning

confidence: 99%

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

et al. 2022

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Background Nighttime hospital admission is often associated with increased mortality risk in various diseases. This study investigated compliance rates with the Surviving Sepsis Campaign (SSC) 3-h bundle for daytime and nighttime emergency department (ED) admissions and the clinical impact of compliance on mortality in patients with septic shock. Methods We conducted an observational study using data from a prospective, multicenter registry for septic shock provided by the Korean Shock Society from 11 institutions from November 2015 to December 2017. The outcome was the compliance rate with the SSC 3-h bundle according to the time of arrival in the ED. Results A total of 2049 patients were enrolled. Compared with daytime admission, nighttime admission was associated with higher compliance with the administration of antibiotics within 3 h (adjusted odds ratio (adjOR), 1.326; 95% confidence interval (95% CI), 1.088–1.617, p = 0.005) and with the complete SSC bundle (adjOR, 1.368; 95% CI, 1.115–1.678; p = 0.003), likely to result from the increased volume of all patients and sepsis patients admitted during daytime hours. The hazard ratios of the completion of SSC bundle for 28-day mortality and in-hospital mortality were 0.750 (95% CI 0.590–0.952, p = 0.018) and 0.714 (95% CI 0.564–0.904, p = 0.005), respectively. Conclusion Septic shock patients admitted to the ED during the daytime exhibited lower sepsis bundle compliance than those admitted at night. Both the higher number of admitted patients and the higher patients to medical staff ratio during daytime may be factors that are responsible for lowering the compliance.

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Section: Discussionmentioning

confidence: 99%

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

et al. 2022

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“…After applying the inclusion and exclusion criteria, 31 articles were retained. Twenty-one of these studies [ 33 , 41 – 60 ] included interventions and reported the effectiveness of these interventions and were subsequently included in a meta-analysis. Eleven studies that reported non-interventional factors are presented as a narrative synthesis.…”

Section: Resultsmentioning

confidence: 99%

Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis

et al. 2022

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Background Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to improve early fluid administration as part of sepsis protocols, the extent to which they have improved compliance with fluid resuscitation is unknown. The factors associated with the lack of compliance are also poorly understood. Methods We conducted a systematic review, meta-analysis and narrative review to investigate the effectiveness of interventions in emergency departments in improving compliance with early fluid administration and examine the non-interventional facilitators and barriers that may influence appropriate fluid administration in adults with sepsis. We searched MEDLINE Ovid/PubMed, Ovid EMBASE, CINAHL, and SCOPUS databases for studies of any design to April 2021. We synthesised results from the studies reporting effectiveness of interventions in a meta-analysis and conducted a narrative synthesis of studies reporting non-interventional factors. Results We included 31 studies out of the 825 unique articles identified in the systematic review of which 21 were included in the meta-analysis and 11 in the narrative synthesis. In meta-analysis, interventions were associated with a 47% improvement in the rate of compliance [(Random Effects (RE) Relative Risk (RR) = 1.47, 95% Confidence Interval (CI), 1.25–1.74, p-value < 0.01)]; an average 24 min reduction in the time to fluids [RE mean difference = − 24.11(95% CI − 14.09 to − 34.14 min, p value < 0.01)], and patients receiving an additional 575 mL fluids [RE mean difference = 575.40 (95% CI 202.28–1353.08, p value < 0.01)]. The compliance rate of early fluid administration reported in the studies included in the narrative synthesis is 48% [RR = 0.48 (95% CI 0.24–0.72)]. Conclusion Performance improvement interventions improve compliance and time and volume of fluids administered to patients with sepsis in the emergency department. While patient-related factors such as advanced age, co-morbidities, cryptic shock were associated with poor compliance, important organisational factors such as inexperience of clinicians, overcrowding and inter-hospital transfers were also identified. A comprehensive understanding of the facilitators and barriers to early fluid administration is essential to design quality improvement projects. PROSPERO Registration ID CRD42021225417.

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“…Secondary outcomes included SEP-1 adherence and hospital-specific risk-adjusted mortality. SEP-1 scores are a percentage from 0 to 100 and represent the proportion of eligible sepsis cases with complete adherence with both (1) a 3-hour bundle of serum lactate measurement, fluid resuscitation, blood cultures, and broad-spectrum antibiotics and (2) a 6-hour bundle including repeat lactate measurement, vasopressor administration, and reassessment of volume status/tissue perfusion. SEP-1 scores were retained as both a continuous measure and categorized by quartile (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…Health care costs in the U.S. due to sepsis are estimated to be over $62 billion annually. (1), (2) Performance improvement activities have been a hallmark of sepsis care since the Surviving Sepsis Campaign developed sepsis bundles and multidisciplinary quality improvement programs many years ago. In addition, performance improvement programs aimed at improving sepsis bundle treatment have demonstrated marked reduction in sepsis mortality even after adjustment for comorbidities, age, and disease severity.…”

Section: Introductionmentioning

confidence: 99%

“…The objectives of this study are to (1) compare sepsis performance improvement activities in hospitals that do and do not report SEP-1 performance and (2) to identify elements of sepsis performance improvement associated with better SEP-1 scores and outcomes. Our goal is to identify elements of sepsis performance improvement processes associated with better SEP-1 scores and outcomes to inform hospital performance improvement programs.…”

Section: Introductionmentioning

confidence: 99%

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Hospitals That Report Severe Sepsis and Septic Shock Bundle (SEP-1) Compliance Have More Structured Sepsis Performance Improvement

et al. 2021

Preprint

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Objective: Sepsis is a common cause of death in hospitalized patients. The Centers for Medicare & Medicaid Service (CMS) Severe Sepsis and Septic Shock Bundle (SEP-1) is an evidence-based early management bundle focused on improving sepsis outcomes. It is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and if those practices reduce sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and non-reporting hospitals and to measure the association between specific elements of sepsis QI processes and SEP-1 performance and hospital-specific risk-adjusted sepsis mortality. Design, Setting, and Patients: This mixed methods study linked telephone survey data on QI practices from Iowa hospitals to SEP-1 performance data and risk-adjusted mortality from statewide all-payer administrative claims database. The survey assessed sepsis QI practices in eight categories. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with hospital SEP-1 performance and observed-to-expected sepsis mortality ratios. Interventions: None Measurements and Main Results: All 118 Iowa hospitals completed the survey (100% response rate). SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% vs. 38%, p = 0.026) and using the case review process to develop sepsis care plans (87% vs. 64%, p = 0.013). Sepsis QI practices were not associated with increased SEP-1 scores. Two were associated with reduced mortality: having a sepsis committee B= -0.11, p = 0.036) and using case review results for sepsis care plans (B= -0.10, p = 0.049). Conclusions: Hospitals reporting SEP-1 compliance to CMS conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.

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Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED

Cited by 17 publications

References 12 publications

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Relationship between time of emergency department admission and adherence to the Surviving Sepsis Campaign bundle in patients with septic shock

Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis

Hospitals That Report Severe Sepsis and Septic Shock Bundle (SEP-1) Compliance Have More Structured Sepsis Performance Improvement

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