Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL)

Venkatesh, Arjun K.; Slesinger, Todd; Whittle, Jessica S.; Osborn, Tiffany M.; Aaronson, Emily; Rothenberg, Craig; Tarrant, Nalani; Goyal, Pawan; Yealy, Donald M.; Schuur, Jeremiah D.

doi:10.1016/j.annemergmed.2017.06.032

Cited by 52 publications

(35 citation statements)

References 9 publications

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“…25 Structural barriers in rural health care delivery related to regionalization networks, limitations in resource availability, and variation in emergency practitioners' training 26 all make adherence with sepsis resuscitation guidelines challenging in the rural setting. Variation in ED sepsis care processes has been shown, 12 yet little is known about modern sepsis care delivery following various statewide and national efforts-particularly in the community and rural setting.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…Variation exists in compliance with well‐established sepsis best practices, an observation that prompts nationwide efforts to improve sepsis care quality. The Centers for Medicare and Medicaid Services (CMS) introduced the first national quality measure of sepsis care for public reporting and hospital accountability, commonly referred to as SEP‐1 .…”

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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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“…Studies cite wide variations in compliance, with some reporting it to be as low as 8.7%. 9,10 Of the 4 performance measures included in the 3-hour bundle, repeated lactate measurement was met least often. 10 As discussed, we are unable to state that a lactate-guided approach is inferior to a peripheral perfusion approach, and it is safe to say it is no better.…”

Section: Discussion Pointsmentioning

confidence: 99%

“…9,10 Of the 4 performance measures included in the 3-hour bundle, repeated lactate measurement was met least often. 10 As discussed, we are unable to state that a lactate-guided approach is inferior to a peripheral perfusion approach, and it is safe to say it is no better. With no evidence that it improves patientimportant outcomes, a government mandate requiring lactate-guided resuscitation strategy adds needless logistic complexity to the already overburdened ED work flow, and it may encourage overresuscitation and the downstream harms associated with such aggressive strategies.…”

Section: Discussion Pointsmentioning

confidence: 99%

Lactate-Guided Resuscitation Strategies in Septic Shock: Differentiating the Bad From the Unexceptional

Spiegel

McNaughton

Radecki

2019

Annals of Emergency Medicine

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“…A lack of usability testing prior to use can result in poor integration within an established workflow. Therefore studies have begun to focus on usability testing of risk prediction CDS tools directly in workflow sensitive settings such as emergency departments (Desautels et al, 2016;Rhodes et al, 2015) and ICUs (Venkatesh et al, 2018). Early stage (formative) usability testing is designed to obtain qualitative reactions to user interface concepts and designs to achieve better understanding of real-world provider decisionmaking processes, and determine how best to provide the meaningful bedside assistance required to achieve the CDS benefits of improved protocol compliance and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Signaling Sepsis Scenario Development & Validation

Weldon

Kowalski

Schubel

et al. 2018

Proceedings of the Human Factors and Ergonomics Society Annual

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Patient-based scenario-driven usability tests are routinely created for health information technology and clinical decision support evaluations. Due to low clinician awareness of sepsis, a study was undertaken to understand clinician performance and preference of different display types for sepsis clinical decision support through multi-centered usability testing. Patient-based clinical scenarios were created to mimic the environment in which providers would interact with clinical decision support. The data provided in the scenarios were drawn from real patient cases from two sepsis databases, including: demographics, visit/operational details, medical history (comorbidities, assessments, vital signs, laboratory values, clinician documentation), and patient disposition/outcomes. The purpose of this work is to inform electronic health record alert optimization and clinical practice workflow to support the effective and timely delivery of high quality sepsis care. This paper discusses the methodology, selection, and validation of patient-based cases used as the clinical scenarios in usability testing.

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Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL)

Cited by 52 publications

References 9 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

Lactate-Guided Resuscitation Strategies in Septic Shock: Differentiating the Bad From the Unexceptional

Signaling Sepsis Scenario Development & Validation

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