Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units

Doerfler, Martin E.; D’Angelo, John; Jacobsen, Diane; Jarrett, Mark; Kabcenell, Andrea; Masick, Kevin D.; Parmentier, Darlene; Nelson, Karen L.; Stier, Lori

doi:10.1016/s1553-7250(15)41027-x

Cited by 20 publications

(15 citation statements)

References 20 publications

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“…Reporting of quality measures by hospitals has grown exponentially in the past decade as federal, state, and private payer programs transition toward quality-based or quality-tiered hospital payment programs. 27 Quality reporting is a valuable tool in sepsis care, as mortality from sepsis is lower at hospitals with higher levels of guideline compliance [28][29][30] and reporting is linked to a reduction in sepsis mortality. 21 Our findings demonstrate that rural EDs can perform well on quality metrics for sepsis care.…”

Section: Discussionmentioning

confidence: 99%

Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States

Greenwood-Ericksen

Rothenberg

Mohr

et al. 2018

The Journal of Rural Health

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Purpose The Centers for Medicare and Medicaid Services (CMS) and the American College of Emergency Physicians (ACEP) developed national quality measures for emergency department (ED) sepsis care. Like care for many conditions, meeting sepsis quality metrics can vary between settings. We sought to examine and compare sepsis care quality in rural vs urban hospital‐based EDs. Methods We analyzed data from EDs participating in the national Emergency Quality Network (E‐QUAL). We collected preliminary performance data on both the CMS measure (SEP‐1) and the ACEP measures via manual chart review. We analyzed SEP‐1 data at the hospital level based on existing CMS definitions and analyzed ACEP measure data at the patient level. We report descriptive statistics of performance variation in rural and urban EDs. Findings Rural EDs comprised 58 of the EDs reporting SEP‐1 results and 405 rural patient charts in the manual review. Of sites reporting SEP‐1 results, 44% were rural and demonstrated better aggregate SEP‐1 bundle adherence than urban EDs (79% vs 71%; P = .049). Both urban and rural hospitals reported high levels of compliance with the ACEP recommended initial actions of obtaining lactate and blood cultures, with urban EDs outperforming rural EDs on metrics of IV fluid administration and antibiotics (74% urban vs 60% rural; P ≤ .001; 91% urban vs 84% rural; P ≤ .001, respectively). Conclusions Sepsis care at both rural and urban EDs often achieves success with national metrics. However, performance on individual components of ED sepsis care demonstrates opportunities for improved processes of care at rural EDs.

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Section: Discussionmentioning

confidence: 99%

Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States

Greenwood-Ericksen

Rothenberg

Mohr

et al. 2018

The Journal of Rural Health

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“…The Northwell Sepsis Database has previously been described in detail. 11,13,14 Briefly, all patients met clinical sepsis criteria: (1) infection AND (2) ≥2 (SIRS) criteria AND (3) ≥1 acute organ dysfunction criterion. Organ dysfunction criteria were hypotension, acute kidney injury (AKI), coagulopathy, altered gas exchange, elevated bilirubin (≥2.0 mg/dL), or altered mental status (AMS; clarified in Supplemental Table 1).…”

Section: Database Design and Structurementioning

confidence: 99%

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

Leisman

Angel

Schneider

et al. 2019

Journal of Hospital Medicine

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epsis is both the most expensive condition treated and the most common cause of death in hospitals in the United States. [1][2][3] Most sepsis patients (as many as 80% to 90%) meet sepsis criteria on hospital arrival, but mortality and costs are higher when meeting criteria after admission. [3][4][5][6] Mechanisms of this increased mortality for these distinct populations are not well explored. Patients who present septic in the emergency department (ED) and patients who present as inpatients likely present very different challenges for recognition, treatment, and monitoring. 7 Yet, how these groups differ by demographic and clinical characteristics, the etiology and severity of infection, and patterns of resuscitation care are not well described. Literature on sepsis epidemiology on hospital wards is particularly limited. 8 This knowledge gap is important. If hospital-presenting sepsis (HPS) contributes disproportionately to disease burd-CHFens, it reflects a high-yield population deserving the focus of quality improvement (QI) initiatives. If specific causes of disparities were identified-eg, poor initial resuscitation-they could be specifically targeted for correction. Given that current treatment guidelines are uniform for the two populations, 9,10 characterizing phenotypic differences could also have implications for both diagnostic and therapeutic recommendations, particularly if the groups display substantially differing clinical

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“…A more close interaction between emergency and intensive care health-workers would be useful in this regard. 14 The introduction of the bundles and guidelines had a tremendous impact in critical patients with cardiac arrest, stroke and pneumonia for example. 15 Following the publication of the SSC guidelines in 2004, the SSC organization demonstrated that their implementation, through multiple strategies, decreased mortality regardless of the size of the institutions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

et al. 2016

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Introduction: Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes. Material and Methods: We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012.Results: In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality.Discussion: There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department. Conclusions: The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.

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Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units

Cited by 20 publications

References 20 publications

Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States

Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

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