Format

Send to

Choose Destination
Am J Respir Crit Care Med. 2018 Dec 1;198(11):1406-1412. doi: 10.1164/rccm.201712-2545OC.

Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative.

Author information

1
1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School at Brown University, Providence, Rhode Island.
2
2 New York State Department of Health, Albany, New York.
3
3 Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.
4
4 IPRO, Lake Success, New York.
5
5 Department of Critical Care and Emergency Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
6
6 University of Michigan, Ann Arbor, Michigan.
7
7 VA Center for Clinical Management Research, Ann Arbor, Michigan.
8
8 New York State Department of Health, Albany, New York.
9
9 Department of Surgery and.
10
10 Department of Emergency Medicine, Washington University, St. Louis, Missouri; and.
11
11 Division of Biostatistics, Ohio State University College of Public Health, Columbus, Ohio.

Abstract

RATIONALE:

In 2013, the New York State Department of Health (NYSDOH) began a mandatory state-wide initiative to improve early recognition and treatment of severe sepsis and septic shock.

OBJECTIVES:

This study examines protocol initiation, 3-hour and 6-hour sepsis bundle completion, and risk-adjusted hospital mortality among adult patients with severe sepsis and septic shock.

METHODS:

Cohort analysis included all patients from all 185 hospitals in New York State reported to the NYSDOH from April 1, 2014, to June 30, 2016. A total of 113,380 cases were submitted to NYSDOH, of which 91,357 hospitalizations from 183 hospitals met study inclusion criteria. NYSDOH required all hospitals to submit and follow evidence-informed protocols (including elements of 3-h and 6-h sepsis bundles: lactate measurement, early blood cultures and antibiotic administration, fluids, and vasopressors) for early identification and treatment of severe sepsis or septic shock.

MEASUREMENTS AND MAIN RESULTS:

Compliance with elements of the sepsis bundles and risk-adjusted mortality were studied. Of 91,357 patients, 74,293 (81.3%) had the sepsis protocol initiated. Among these individuals, 3-hour bundle compliance increased from 53.4% to 64.7% during the study period (P < 0.001), whereas among those eligible for the 6-hour bundle (n = 35,307) compliance increased from 23.9% to 30.8% (P < 0.001). Risk-adjusted mortality decreased from 28.8% to 24.4% (P < 0.001) in patients among whom a sepsis protocol was initiated. Greater hospital compliance with 3-hour and 6-hour bundles was associated with shorter length of stay and lower risk and reliability-adjusted mortality.

CONCLUSIONS:

New York's statewide initiative increased compliance with sepsis-performance measures. Risk-adjusted sepsis mortality decreased during the initiative and was associated with increased hospital-level compliance.

KEYWORDS:

implementation science; performance improvement; quality; sepsis

PMID:
30189749
PMCID:
PMC6290949
[Available on 2019-12-01]
DOI:
10.1164/rccm.201712-2545OC

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center