The Impact of the Location of Sepsis Presentation on Compliance to Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures: A Retrospective Cohort study

Abstract

Objectives: In 2015, the Centers for Medicare and Medicaid Services implemented Severe Sepsis (SS) and Septic Shock (SSh) core measures. This study compared compliance to the measures between Emergency Department (ED) and Inpatients (IP). Secondary objectives included compliance to each bundle component, risk factors for noncompliance, hospital and ICU Length Of Stay (LOS), 30-day mortality, and antibiotic initiation within one hour of presentation. Methods:A retrospective, single-center and cohort study. Included patients with admission ICD code of SS and SSh between January 1 -June 30, 2016. Patients were excluded if they were less than 18 years of age, admitted with other types of shock (including cardiogenic shock, hemorrhagic shock and anaphylactoid reaction), pregnancy, expired within 6 hours of presentation, admitted to a hospice or palliative care/withdrawal of care before full therapy could be conducted, and transferred from another facility including transferred Results: 272 encounters were screened; 118 were excluded. The 154 remaining subjects were distributed in a 2:1 ratio between ED and IP (ICUs and other hospital floors). For SS, overall 3-hour bundle compliance was 60.6% in ED vs. 34 % in IP (P = 0.003); and overall 6-hour bundle compliance was 51% in ED vs. 25 % in IP (P = 0.046). There were no differences in 3 or 6-hour bundle compliance for SSh. Comparing individual components, only the initial and repeated lactate rates were different: ED -78.8% vs. IP -46%; p < 0.001, and ED -51% vs. IP -25%; p= 0.046, respectively. Hospital and ICU LOS was shorter in the ED arm. Antibiotic initiation in one hour occurred more often in the IP arm (56% vs. 10.6%; P = 0.001). 30-day mortality was not different. Marwa Conclusion:In this study, core measure compliance is higher when sepsis presents in the ED. Utilizing such data will guide targeted efforts for sepsis bundles compliance.