IHI ID 10 Improved compliance with early sepsis management is associated with shorter hospital stay. (December 2018)

• Record Type: Journal Article
• Authors: Rodriguez-Homs, Larissa; Masoud, Sabran; Jawitz, Oliver; Phillips, Harry; O'Brien, Cara; Mosca, Paul
• Is Part Of: BMJ open quality. Volume 7:Supplement 1(2018)
• Page Start: A14
• Page End: A15
• Publication Date: 2018-12
• Subjects: Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/ihisciabs.10
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Background: In 2018, Medicare began public reporting of hospital compliance with Sepsis and Septic Shock Early Management (SEP-1) bundle. We queried whether a relationship between SEP-1 bundle compliance, hospital size, and global measures of quality exists. Objectives: To determine the relationship between SEP-1 bundle compliance and hospital size, composite complication rate (PSI-90), average length of stay (ALOS) and hospital readmission rate. Methods: Data was obtained from Medicares Hospital Compare online database and The American Hospital Directory. Records missing SEP-1, complications, and discharge data were excluded. Pearson correlation, controlling for staffed beds, and an independent t-test were used for analysis. Results: A total of 2796 hospitals met inclusion criteria. An increased SEP-1 score was negatively associated with PSI-90 (r=−0.103, p<0.001), staffed bed number (r=−0.114, p<0.001), and ALOS (r=−0.118, p<0.001). There was no association with 30 day readmission rate (p=0.480). PSI-90 and ALOS remained significantly correlated with SEP-1 while adjusting for staffed beds. Figures 1 to 4 show independent t-test results relating SEP-1 scores to higher – and lower-performing hospitals on each of the indicated quality measures. Conclusions: Higher performance on SEP-1 compliance is associated with lower composite complication rate and shorter length of stay. The inverse relationship between SEP-1 compliance and hospital size may reflect the challenges associated with implementation of new protocols in large, complex hospitals. While this study does not establish a causal relationship, the ability of hospitals to successfully implement SEP-1 may suggest a higher level of overall operational excellence.