Mitchell M Levy1, Foster C Gesten2, Gary S Phillips3, Kathleen M Terry4, Christopher W Seymour5, Hallie C Prescott6,7, Marcus Friedrich8, Theodore J Iwashyna6,7, Tiffany Osborn9,10, Stanley Lemeshow11. 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.
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.
Authors: Vincent X Liu; Vikram Fielding-Singh; John D Greene; Jennifer M Baker; Theodore J Iwashyna; Jay Bhattacharya; Gabriel J Escobar Journal: Am J Respir Crit Care Med Date: 2017-10-01 Impact factor: 21.405
Authors: Vincent X Liu; John W Morehouse; Gregory P Marelich; Jay Soule; Thomas Russell; Melinda Skeath; Carmen Adams; Gabriel J Escobar; Alan Whippy Journal: Am J Respir Crit Care Med Date: 2016-06-01 Impact factor: 21.405
Authors: Christopher W Seymour; Foster Gesten; Hallie C Prescott; Marcus E Friedrich; Theodore J Iwashyna; Gary S Phillips; Stanley Lemeshow; Tiffany Osborn; Kathleen M Terry; Mitchell M Levy Journal: N Engl J Med Date: 2017-05-21 Impact factor: 91.245
Authors: D C Angus; A E Barnato; D Bell; R Bellomo; C-R Chong; T J Coats; A Davies; A Delaney; D A Harrison; A Holdgate; B Howe; D T Huang; T Iwashyna; J A Kellum; S L Peake; F Pike; M C Reade; K M Rowan; M Singer; S A R Webb; L A Weissfeld; D M Yealy; J D Young Journal: Intensive Care Med Date: 2015-05-08 Impact factor: 17.440
Authors: Hallie C Prescott; Theodore J Iwashyna; Bronagh Blackwood; Thierry Calandra; Linda L Chlan; Karen Choong; Bronwen Connolly; Paul Dark; Luigi Ferrucci; Simon Finfer; Timothy D Girard; Carol Hodgson; Ramona O Hopkins; Catherine L Hough; James C Jackson; Flavia R Machado; John C Marshall; Cheryl Misak; Dale M Needham; Pinaki Panigrahi; Konrad Reinhart; Sachin Yende; Ross Zafonte; Kathryn M Rowan; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2019-10-15 Impact factor: 21.405
Authors: Jeremy M Kahn; Billie S Davis; Jonathan G Yabes; Chung-Chou H Chang; David H Chong; Tina Batra Hershey; Grant R Martsolf; Derek C Angus Journal: JAMA Date: 2019-07-16 Impact factor: 56.272
Authors: Keith Corl; Mitchell Levy; Gary Phillips; Kathleen Terry; Marcus Friedrich; Amal N Trivedi Journal: Health Aff (Millwood) Date: 2019-07 Impact factor: 6.301