Skip to main content
Erschienen in: Journal of General Internal Medicine 4/2020

10.02.2020

Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study

verfasst von: Jonathan D. Baghdadi, MD, PhD, Mitchell D. Wong, MD, PhD, Daniel Z. Uslan, MD, MBA, Douglas Bell, MD, PhD, William E. Cunningham, MD, MPH, Jack Needleman, PhD, Russell Kerbel, MD, Robert Brook, MD, ScD

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Sepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis.

Objective

To compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis.

Design

Retrospective cohort study using multivariable analysis of clinical data.

Participants

A total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection.

Setting

Four university hospitals in California between 2014 and 2016.

Main Outcomes and Measures

The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen.

Key Results

Compared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29–0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated—blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)—was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004).

Conclusions

Inpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Mayr, F.B., S. Yende, and D.C. Angus, Epidemiology of severe sepsis. Virulence, 2014. 5(1): p. 4–11.PubMedCrossRef Mayr, F.B., S. Yende, and D.C. Angus, Epidemiology of severe sepsis. Virulence, 2014. 5(1): p. 4–11.PubMedCrossRef
3.
Zurück zum Zitat Novosad, S.A., Vital signs: epidemiology of sepsis: prevalence of health care factors and opportunities for prevention. MMWR. Morbidity and mortality weekly report, 2016. 65. Novosad, S.A., Vital signs: epidemiology of sepsis: prevalence of health care factors and opportunities for prevention. MMWR. Morbidity and mortality weekly report, 2016. 65.
4.
5.
Zurück zum Zitat Jones, S.L., et al., Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type. Med Care, 2016. 54(3): p. 303–10.PubMedPubMedCentralCrossRef Jones, S.L., et al., Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type. Med Care, 2016. 54(3): p. 303–10.PubMedPubMedCentralCrossRef
7.
Zurück zum Zitat Paoli, C.J., et al., Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level. Critical care medicine, 2018. 46(12): p. 1889–1897.PubMedPubMedCentralCrossRef Paoli, C.J., et al., Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level. Critical care medicine, 2018. 46(12): p. 1889–1897.PubMedPubMedCentralCrossRef
8.
Zurück zum Zitat Seymour, C.W., et al., Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. New England Journal of Medicine, 2017. 376(23): p. 2235–2244.PubMedCrossRef Seymour, C.W., et al., Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. New England Journal of Medicine, 2017. 376(23): p. 2235–2244.PubMedCrossRef
9.
Zurück zum Zitat Odden, A.J., et al., A Systematic Assessment of the Surviving Sepsis Campaign's Evidence Supporting the Care of Patients with Severe Sepsis on the Wards. Ann Am Thorac Soc, 2015. 12(6): p. 956–8.PubMedPubMedCentralCrossRef Odden, A.J., et al., A Systematic Assessment of the Surviving Sepsis Campaign's Evidence Supporting the Care of Patients with Severe Sepsis on the Wards. Ann Am Thorac Soc, 2015. 12(6): p. 956–8.PubMedPubMedCentralCrossRef
10.
Zurück zum Zitat Rhee, C., et al., Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study. Crit Care Med, 2018. 46(10): p. 1585–1591.PubMedPubMedCentralCrossRef Rhee, C., et al., Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study. Crit Care Med, 2018. 46(10): p. 1585–1591.PubMedPubMedCentralCrossRef
11.
Zurück zum Zitat Milano, P.K., et al., Sepsis Bundle Adherence Is Associated with Improved Survival in Severe Sepsis or Septic Shock. West J Emerg Med, 2018. 19(5): p. 774–781.PubMedPubMedCentralCrossRef Milano, P.K., et al., Sepsis Bundle Adherence Is Associated with Improved Survival in Severe Sepsis or Septic Shock. West J Emerg Med, 2018. 19(5): p. 774–781.PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Dellinger, R.P., et al., Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013. 41(2): p. 580–637.PubMedCrossRef Dellinger, R.P., et al., Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013. 41(2): p. 580–637.PubMedCrossRef
13.
Zurück zum Zitat Commission, J., Specifications manual for national hospital inpatient quality measures. Version 5.2, 2017. Commission, J., Specifications manual for national hospital inpatient quality measures. Version 5.2, 2017.
15.
Zurück zum Zitat Venkatesh, A.K., et al., Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL). Ann Emerg Med, 2017. Venkatesh, A.K., et al., Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL). Ann Emerg Med, 2017.
17.
Zurück zum Zitat Rhodes, A., et al., The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med, 2015. 41(9): p. 1620–8.PubMedCrossRef Rhodes, A., et al., The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med, 2015. 41(9): p. 1620–8.PubMedCrossRef
18.
Zurück zum Zitat Singer, M., et al., The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016. 315. Singer, M., et al., The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016. 315.
19.
Zurück zum Zitat Elixhauser, A., et al., Comorbidity measures for use with administrative data. Medical care, 1998. 36(1): p. 8–27.PubMedCrossRef Elixhauser, A., et al., Comorbidity measures for use with administrative data. Medical care, 1998. 36(1): p. 8–27.PubMedCrossRef
20.
Zurück zum Zitat Moore, B.J., et al., Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index. Med Care, 2017. 55(7): p. 698–705.PubMedCrossRef Moore, B.J., et al., Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index. Med Care, 2017. 55(7): p. 698–705.PubMedCrossRef
21.
Zurück zum Zitat Martin, G.S., et al., The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine, 2003. 348(16): p. 1546–1554.PubMedCrossRef Martin, G.S., et al., The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine, 2003. 348(16): p. 1546–1554.PubMedCrossRef
22.
Zurück zum Zitat Lagu, T., et al., What is the best method for estimating the burden of severe sepsis in the United States? J Crit Care, 2012. 27(4): p. 414.e1–9.CrossRef Lagu, T., et al., What is the best method for estimating the burden of severe sepsis in the United States? J Crit Care, 2012. 27(4): p. 414.e1–9.CrossRef
23.
Zurück zum Zitat Kumar, G., et al., Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest, 2011. 140(5): p. 1223–1231.PubMedCrossRef Kumar, G., et al., Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest, 2011. 140(5): p. 1223–1231.PubMedCrossRef
24.
Zurück zum Zitat Stoller, J., et al., Epidemiology of severe sepsis: 2008-2012. J Crit Care, 2015. Stoller, J., et al., Epidemiology of severe sepsis: 2008-2012. J Crit Care, 2015.
25.
Zurück zum Zitat Zou, G., A Modified Poisson Regression Approach to Prospective Studies with Binary Data. American Journal of Epidemiology, 2004. 159(7): p. 702–706.PubMedCrossRef Zou, G., A Modified Poisson Regression Approach to Prospective Studies with Binary Data. American Journal of Epidemiology, 2004. 159(7): p. 702–706.PubMedCrossRef
26.
Zurück zum Zitat Seymour, C.W., et al., Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. JAMA, 2019. 321(20): p. 2003–2017.PubMedPubMedCentralCrossRef Seymour, C.W., et al., Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. JAMA, 2019. 321(20): p. 2003–2017.PubMedPubMedCentralCrossRef
27.
Zurück zum Zitat Mahajan, A., et al., A hospital is not just a factory, but a complex adaptive system—implications for perioperative care. Anesthesia & Analgesia, 2017. 125(1): p. 333–341.CrossRef Mahajan, A., et al., A hospital is not just a factory, but a complex adaptive system—implications for perioperative care. Anesthesia & Analgesia, 2017. 125(1): p. 333–341.CrossRef
28.
Zurück zum Zitat Nugus, P., et al., Integrated care in the emergency department: A complex adaptive systems perspective. Social Science & Medicine, 2010. 71(11): p. 1997–2004.CrossRef Nugus, P., et al., Integrated care in the emergency department: A complex adaptive systems perspective. Social Science & Medicine, 2010. 71(11): p. 1997–2004.CrossRef
29.
Zurück zum Zitat Durning, S.J., et al., The impact of selected contextual factors on experts’ clinical reasoning performance (does context impact clinical reasoning performance in experts?). Advances in Health Sciences Education, 2012. 17(1): p. 65–79.PubMedCrossRef Durning, S.J., et al., The impact of selected contextual factors on experts’ clinical reasoning performance (does context impact clinical reasoning performance in experts?). Advances in Health Sciences Education, 2012. 17(1): p. 65–79.PubMedCrossRef
30.
Zurück zum Zitat McBee, E., et al., Consequences of contextual factors on clinical reasoning in resident physicians. Adv Health Sci Educ Theory Pract, 2015. 20(5): p. 1225–36.PubMedCrossRef McBee, E., et al., Consequences of contextual factors on clinical reasoning in resident physicians. Adv Health Sci Educ Theory Pract, 2015. 20(5): p. 1225–36.PubMedCrossRef
31.
32.
Zurück zum Zitat Pepper, D.J., et al., Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1): A Systematic Review. Ann Intern Med, 2018. 168(8): p. 558–568.PubMedCrossRef Pepper, D.J., et al., Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1): A Systematic Review. Ann Intern Med, 2018. 168(8): p. 558–568.PubMedCrossRef
33.
Zurück zum Zitat Miguel, N., et al., Sepsis-related organ failure assessment and withholding or withdrawing life support from critically ill patients. Critical care (London, England), 1998. 2(2): p. 61–66.CrossRef Miguel, N., et al., Sepsis-related organ failure assessment and withholding or withdrawing life support from critically ill patients. Critical care (London, England), 1998. 2(2): p. 61–66.CrossRef
34.
Zurück zum Zitat Torsvik, M., et al., Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Critical Care, 2016. 20(1): p. 244.PubMedPubMedCentralCrossRef Torsvik, M., et al., Early identification of sepsis in hospital inpatients by ward nurses increases 30-day survival. Critical Care, 2016. 20(1): p. 244.PubMedPubMedCentralCrossRef
35.
Zurück zum Zitat Bruce, H.R., et al., Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality. Journal of Emergency Nursing, 2015. 41(2): p. 130–137.PubMedCrossRef Bruce, H.R., et al., Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality. Journal of Emergency Nursing, 2015. 41(2): p. 130–137.PubMedCrossRef
36.
Zurück zum Zitat Sochalski, J., Is More Better?: The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospitals. Medical Care, 2004. 42(2): p. II-67-II-73. Sochalski, J., Is More Better?: The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospitals. Medical Care, 2004. 42(2): p. II-67-II-73.
37.
Zurück zum Zitat Lucero, R.J., E.T. Lake, and L.H. Aiken, Variations in nursing care quality across hospitals. Journal of advanced nursing, 2009. 65(11): p. 2299–2310.PubMedPubMedCentralCrossRef Lucero, R.J., E.T. Lake, and L.H. Aiken, Variations in nursing care quality across hospitals. Journal of advanced nursing, 2009. 65(11): p. 2299–2310.PubMedPubMedCentralCrossRef
38.
Zurück zum Zitat Shankar-Hari, M., D.A. Harrison, and K.M. Rowan, Differences in Impact of Definitional Elements on Mortality Precludes International Comparisons of Sepsis Epidemiology-A Cohort Study Illustrating the Need for Standardized Reporting. Crit Care Med, 2016. 44(12): p. 2223–2230.PubMedCrossRef Shankar-Hari, M., D.A. Harrison, and K.M. Rowan, Differences in Impact of Definitional Elements on Mortality Precludes International Comparisons of Sepsis Epidemiology-A Cohort Study Illustrating the Need for Standardized Reporting. Crit Care Med, 2016. 44(12): p. 2223–2230.PubMedCrossRef
39.
Zurück zum Zitat Kempker, J.A. and G.S. Martin, Does Sepsis Case Mix Heterogeneity Prevent Outcome Comparisons? Critical care medicine, 2016. 44(12): p. 2288–2289.PubMedPubMedCentralCrossRef Kempker, J.A. and G.S. Martin, Does Sepsis Case Mix Heterogeneity Prevent Outcome Comparisons? Critical care medicine, 2016. 44(12): p. 2288–2289.PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Rhodes, A., et al., Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 2017. 43(3): p. 304–377.PubMedCrossRef Rhodes, A., et al., Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 2017. 43(3): p. 304–377.PubMedCrossRef
41.
Zurück zum Zitat Rhee, C., et al., Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality. JAMA Network Open, 2019. 2(2): p. e187571-e187571.PubMedPubMedCentralCrossRef Rhee, C., et al., Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality. JAMA Network Open, 2019. 2(2): p. e187571-e187571.PubMedPubMedCentralCrossRef
42.
Zurück zum Zitat Aaronson, E.L., et al., New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field. J Emerg Med, 2017. 52(1): p. 109–116.PubMedCrossRef Aaronson, E.L., et al., New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field. J Emerg Med, 2017. 52(1): p. 109–116.PubMedCrossRef
43.
Zurück zum Zitat Gonet, J., et al., Interrate Reliability for SEP-1 Abstraction in a Multihospital Medical Center. Critical Care Medicine, 2016. 44(12): p. 96.CrossRef Gonet, J., et al., Interrate Reliability for SEP-1 Abstraction in a Multihospital Medical Center. Critical Care Medicine, 2016. 44(12): p. 96.CrossRef
44.
Zurück zum Zitat Rhee, C., et al., Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure. Infection Control & Hospital Epidemiology, 2018. 39(8): p. 994–996.CrossRef Rhee, C., et al., Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure. Infection Control & Hospital Epidemiology, 2018. 39(8): p. 994–996.CrossRef
Metadaten
Titel
Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study
verfasst von
Jonathan D. Baghdadi, MD, PhD
Mitchell D. Wong, MD, PhD
Daniel Z. Uslan, MD, MBA
Douglas Bell, MD, PhD
William E. Cunningham, MD, MPH
Jack Needleman, PhD
Russell Kerbel, MD
Robert Brook, MD, ScD
Publikationsdatum
10.02.2020
Verlag
Springer International Publishing
Erschienen in
Journal of General Internal Medicine / Ausgabe 4/2020
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-020-05653-0

Weitere Artikel der Ausgabe 4/2020

Journal of General Internal Medicine 4/2020 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.