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

2021 ◽  
Author(s):  
Ty B. Bolte ◽  
Morgan B. Swanson ◽  
Anna Kaldjian ◽  
Nicholas M. Mohr ◽  
Jennifer McDanel ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Performance Improvement ◽  
Administrative Claims ◽  
Case Review ◽  
Sepsis Mortality ◽  
Early Management ◽  
Care Plans ◽  
Sepsis And Septic Shock ◽  
Sepsis Care

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.

113 Use of Computerized Sepsis Care Plans Improved Resuscitation Parameters in Patients With Severe Sepsis and Septic Shock

2014 ◽  
Vol 64 (4) ◽  
pp. S41
Author(s):  
E. Giesler ◽  
R. Sherwin ◽  
C. Courage ◽  
S. Stewart ◽  
A. Fiorvento ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Care Plans ◽  
Sepsis And Septic Shock ◽  
Sepsis Care

scholarly journals Traditional Chinese Medicine Diagnosis “Yang-Xu Zheng”: Significant Prognostic Predictor for Patients with Severe Sepsis and Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Sunny Jui-Shan Lin ◽  
Yung-Yen Cheng ◽  
Chih-Hung Chang ◽  
Cheng-Hung Lee ◽  
Yi-Chia Huang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Regression Analysis ◽  
Severe Sepsis ◽  
Host Response ◽  
Multivariate Logistic Regression Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Multivariate Logistic Regression ◽  
Sepsis Mortality ◽  
Sepsis And Septic Shock

Pathogenesis of sepsis includes complex interaction between pathogen activities and host response, manifesting highly variable signs and symptoms, possibly delaying diagnosis and timely life-saving interventions. This study applies traditional Chinese medicine (TCM)Zhengdiagnosis in patients with severe sepsis and septic shock to evaluate its adaptability and use as an early predictor of sepsis mortality. Three-year prospective observational study enrolled 126 septic patients. TCMZhengdiagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and blood samples for host response cytokines measurement (tumor necrosis factor-α, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-18) were collected within 24 hours after admission to Intensive Care Unit. Main outcome was 28-day mortality; multivariate logistic regression analysis served to determine predictive variables of the sepsis mortality. APACHE II score, frequency ofNutrient-phase heat, andQi-XuandYang-Xu Zhengswere significantly higher in nonsurvivors. The multivariate logistic regression analysis identifiedYang-Xu Zhengas the outcome predictor. APACHE II score and levels of five host response cytokines between patients with and withoutYang-Xu Zhengrevealed significant differences. Furthermore, cool extremities and weak pulse, both diagnostic signs ofYang-Xu Zheng, were also proven independent predictors of sepsis mortality. TCM diagnosis “Yang-Xu Zheng” may provide a new mortality predictor for septic patients.

Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality*

2007 ◽  
Vol 35 (4) ◽  
pp. 1105-1112 ◽  
Author(s):  
H Bryant Nguyen ◽  
Stephen W. Corbett ◽  
Robert Steele ◽  
Jim Banta ◽  
Robin T. Clark ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Quality Indicators ◽  
Early Management ◽  
Sepsis And Septic Shock

scholarly journals Infectious Diseases Team for the Early Management of Severe Sepsis and Septic Shock in the Emergency Department

2017 ◽  
Vol 65 (8) ◽  
pp. 1253-1259 ◽  
Author(s):  
Pierluigi Viale ◽  
Sara Tedeschi ◽  
Luigia Scudeller ◽  
Luciano Attard ◽  
Lorenzo Badia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Infectious Diseases ◽  
Early Management ◽  
Sepsis And Septic Shock

scholarly journals Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure

2020 ◽  
Author(s):  
Chanu Rhee ◽  
Kathleen Chiotos ◽  
Sara E Cosgrove ◽  
Emily L Heil ◽  
Sameer S Kadri ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Infectious Diseases ◽  
Unintended Consequences ◽  
Position Paper ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Early Management ◽  
Treatment Standard ◽  
Sepsis And Septic Shock

Abstract The Centers for Medicare & Medicaid Services’ Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1’s potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1’s complex “time zero” definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA’s core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.

scholarly journals 770. Multimodal Sepsis Performance Improvement Initiative Improves Early and Appropriate Treatment, Reduces Sepsis-related Readmissions, and Reduces Overall Mortality

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S343
Author(s):  
Seife Yohannes
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Performance Improvement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Sepsis And Septic Shock

Abstract Background CMS has implemented the SEP-1 Core Measure, which mandates that hospitals implement sepsis quality improvement initiatives. At our hospital, a 900-bed tertiary hospital, a sepsis performance improvement initiative was implemented in April 2016. In this study, we analyzed patient outcomes before and after these interventions. Methods We studied coding data in patients with a diagnosis of Sepsis reported to CMS using a third-party performance improvement database between October, 2015 and July, 2017. The interventions included a hospital-wide education campaign about sepsis; a 24–7 electronic warning system (EWS) using SIRS criteria; a rapid response nursing team that monitors the EWS; a 24–7 mid-level provider team; a database to monitor compliance and timely treatment; and education in sepsis documentation and coding. We performed a before and after analysis of patient outcomes. Results A total of 4,102 patients were diagnosed with sepsis during the study period. 861 (21%) were diagnosed during the pre-intervention period and 3,241 (80%) were diagnosed in the post-intervention period. The overall incidence of sepsis, severe sepsis, and septic shock were 59%, 13%, and 28% consecutively. Regression analysis showed age, admission through the ED, and severity of illness as independent risk factors for increased mortality. Adjusted for these risk factors, the incidence of severe sepsis and septic was reduced by 5.3% and 6.9% in the post-intervention period, while the incidence of simple sepsis increased by 12%. In the post-intervention period, compliance with all 6 CMS mandated sepsis bundle interventions improved from 11% to 37% (P = 0.01); hospital length of stay was reduced by 1.8 days (P = 0.05); length of stay above predicted was less by 1.5 days (P = 0.05); re-admission rate was reduced by 1.6% (P = 0.05); and death from any sepsis diagnosis was reduced 4.5% (P = 0.01). Based on an average of 2000 sepsis cases at our hospital, this amounted to 90 lives saved per year. Death from severe sepsis and septic shock both were also reduced by 5% (P = 0.01) and 6.5% (P = 0.01). Conclusion A multi-modal sepsis performance improvement initiative reduced the incidence of severe sepsis and septic shock, reduced hospital length of stay, reduced readmission rates, and reduced all-cause mortality. Disclosures All authors: No reported disclosures.

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