Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System*

Afshar, Majid; Arain, Erum; Wang, Hongzhi; Gilbert, Emily; Xie, Meng; Lee, Josh; Churpek, Matthew M.; Durazo‐Arvizu, Ramón; Markossian, Talar; Joyce, Cara

doi:10.1097/ccm.0000000000003919

Cited by 45 publications

(62 citation statements)

References 31 publications

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“…We believe our findings support quality improvement programs to implement sepsis bundles with an early detection protocol, but disentangling the pieces of the protocol including sites of infection, antibiotic stewardship, and predominant pathogens were outside the scope of our current study by Afshar et al (2). Our findings are hypothesis-generating for future clinical trials to examine treatment protocols in patients at-risk for sepsis.…”

supporting

confidence: 65%

“…Hospitals have built customized protocols to guide adherence to the 3-and 6-hour sepsis bundle and they report their compliance rate for patients coded as septic, severely septic, or septic shock (3). Our study (2) was not based on administrative data and case definition was inclusive of providers suspecting infection as determined through the electronic health record orders. The focus of our intervention was to improve provider knowledge and awareness through education and system alerts so no qualifying patients were missed for the Severe Sepsis/Septic Shock bundle.…”

mentioning

confidence: 99%

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Afshar

Markossian

Joyce

2020

Critical Care Medicine

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We thank Ishii et al (1) for their comments on our recently published study (2) in Critical Care Medicine, examining a sepsis quality improvement program. We have summarized the authors' concerns as the following: 1) a broad case definition of suspected infection that may bias the cost-savings by including more patients with milder disease; 2) paucity of evidence to provide sepsis care to patients with suspected infection but without meeting sepsis criteria; 3) lack of information detailing the pathogens and antibiotic stewardship.

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supporting

confidence: 65%

mentioning

confidence: 99%

The authors reply

Afshar

Markossian

Joyce

2020

Critical Care Medicine

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“…Sepsis screening has evolved over the last three decades, starting with SIRS, quick sequential organ failure assessment (qSOFA), and now re-interest in SIRS [10][11][12][13]. The deployment of sepsis bundles, assessing compliance, and public reporting have been reported to reduce the length of stay and risk-adjusted mortality [14,15]. Additional studies have evaluated the impact of dedicated staffing [16], electronic medical record alerts [17,18], and other machine-learning-driven research [19] on sepsis metrics.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Urosepsis and Abdominal Imaging

Siddiqui¹,

Abuelroos²,

Qu³

et al. 2021

Cureus

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IntroductionInsufficient attention has been directed towards urosepsis. Notably, no protocols or clinical decision rules currently exist outlining the appropriate use of imaging in uroseptic patients. The primary objective of our study was to retrospectively evaluate uroseptic emergency department (ED) patients who underwent abdominal imaging, to report the proportion of patients with imaging findings necessitating emergent surgical consultation. MethodsWe retrospectively identified 1142 patients ≥ 18 years of age that presented to the ED from January 2009 to December 2012 with ICD9 code indicative of urosepsis. All included patients underwent ED-ordered abdominal computerized tomography (CT) or retroperitoneal ultrasound (US). Imaging and urinalysis (UA) results were categorized. We report proportions with odds ratios and 95% confidence intervals. ResultsOf 1142 patients, we excluded 80 for neg UA, 167 for < 2 SIRS (systemic inflammatory response syndrome), 320 for positive blood cultures, and 37 for incomplete data. This yielded 538 patients which the authors reviewed the results of the CT or US to determine the proportion who required emergent surgical consultation and who underwent surgical or interventional procedure. There were 243 (45%) that had CT or US results that necessitated emergency surgical consultation, of those 180 (33%) underwent surgical or interventional procedure. Similar rates of emergency surgical consultation occurred when sub-divided by positive versus equivocal UA, with 43% and 47%, respectively. ConclusionsForty-five percent of our abdominally imaged urosepsis cohort had imaging findings that necessitated emergent surgical consultation, with a similar proportion in the subset with positive versus equivocal UA. The utility of abdominal imaging in this population should be studied prospectively.

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“…Sepsis remains the most common cause of death in the intensive care unit (ICU), accounting for 1 in 3 hospital deaths ( 2 ). Sepsis is also the most expensive in-hospital diagnosis in the U.S. today ( 3 ). Even with these staggering numbers, the impact of sepsis on patients, their families, and the community is grossly underestimated as survivors experience multiple ongoing morbidities ( 4 ).…”

Section: Sepsis Is a National Crisismentioning

confidence: 99%

Immunological Endotyping of Chronic Critical Illness After Severe Sepsis

et al. 2021

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Improved management of severe sepsis has been one of the major health care accomplishments of the last two decades. Due to enhanced recognition and improved management of severe sepsis, in-hospital mortality has been reduced by up to 40%. With that good news, a new syndrome has unfortunately replaced in-hospital multi-organ failure and death. This syndrome of chronic critical illness (CCI) includes sepsis patients who survive the early “cytokine or genomic storm,” but fail to fully recover, and progress into a persistent state of manageable organ injury requiring prolonged intensive care. These patients are commonly discharged to long-term care facilities where sepsis recidivism is high. As many as 33% of sepsis survivors develop CCI. CCI is the result, at least in part, of a maladaptive host response to chronic pattern-recognition receptor (PRR)-mediated processes. This maladaptive response results in dysregulated myelopoiesis, chronic inflammation, T-cell atrophy, T-cell exhaustion, and the expansion of suppressor cell functions. We have defined this panoply of host responses as a persistent inflammatory, immune suppressive and protein catabolic syndrome (PICS). Why is this important? We propose that PICS in survivors of critical illness is its own common, unique immunological endotype driven by the constant release of organ injury-associated, endogenous alarmins, and microbial products from secondary infections. While this syndrome can develop as a result of a diverse set of pathologies, it represents a shared outcome with a unique underlying pathobiological mechanism. Despite being a common outcome, there are no therapeutic interventions other than supportive therapies for this common disorder. Only through an improved understanding of the immunological endotype of PICS can rational therapeutic interventions be designed.

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Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System*

Cited by 45 publications

References 31 publications

The authors reply

The authors reply

Emergency Department Urosepsis and Abdominal Imaging

Immunological Endotyping of Chronic Critical Illness After Severe Sepsis

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