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Compliance with SEP-1 guidelines is associated with improved outcomes for septic shock but not for severe sepsis

Journal of Intensive Medicine 2022年第3期2卷 167-172页

作者： shelly nbsloan Nate Rodriguez Thomas Seward Lucy Sare Lukas Moore Greg Stahl Kerry Johnson Scott Goade Robert Arnce Department of Primary Care College of MedicineKansas City University2901St.Johns Blvd.JoplinMO 64804USA Department of Quality Improvement Freeman Health SystemJoplinMO 64804USA Department of Mathematics Missouri Southern State UniversityJoplinMO 64801USA Department of Pharmacy Freeman Health SystemJoplinMO 64804USA

Background: In 2018, the Centers for Medicaid and Medicare Services (CMS) issued a protocol for the treatment of sepsis. This bundle protocol, titled SEP-1 is a multicomponent 3 h and 6 h resuscitation treatment for patients with the diagnosis of either severe sepsis or septic shock. The SEP-1 bundle includes antibiotic administration, fluid bolus, blood cultures, lactate measurement, vasopressors for fluid-refractory hypotension, and a reevaluation of volume status. We performed a retrospective analysis of patients diagnosed with either severe sepsis or septic shock comparing mortality outcomes based on compliance with the updated SEP-1 bundle at a rural community hospital. Methods: Mortality outcome and readmission data were extracted from an electronic medical records database from January 1, 2019, to June 30, 2020. International Classification of Diseases (ICD)-10 codes were used to identify patients with either severe sepsis or septic shock. Once identified, patients were separated into four populations: patients with severe sepsis who met SEP-1, patients with severe sepsis who failed SEP-1, patients with septic shock who met SEP-1, and patients with septic shock who failed SEP-1. A patient who met bundle criteria (SEP-1 criteria) received each component of the bundle in the time allotted. Using chi-squared test of homogeneity, mortality outcomes for population proportions were investigated. Two sample proportion summary hypothesis test and 95% confidence intervals (CI) determined significance in mortality outcomes. Results: Out of our 1122 patient population, 437 patients qualified to be measured by CMS criteria. Of the 437 patients, 195 met the treatment bundle and 242 failed the treatment bundle. Upon comparing the two groups, we found the probable difference in mortality rate between the met(14.87%) and failed bundle(27.69%) groups to be significant(95% CI: 5.28-20.34, P = 0.0013). However, the driving force of this result lies in the subgroup of patients w

关键词： SEP-1 Sepsis Early goal-directed therapy Centers for Medicaid and Medicare Services Quality improvement Reimbursement

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