Margaret B Greenwood-Ericksen1, Craig Rothenberg2,3, Nicholas Mohr4, Shawn D Andrea5, Todd Slesinger6, Tiffany Osborn7, Jessica Whittle8, Pawan Goyal9, Nalani Tarrant9, Jeremiah D Schuur10, Donald M Yealy11, Arjun Venkatesh2,3. 1. Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico. 2. Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut. 3. Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut. 4. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 5. Tsehootsooi Medical Center, Fort Defiance, Arizona. 6. Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. 7. Department of Surgery, Acute and Critical Care Surgery and Department of Medicine, Emergency Medicine, Washington University, St. Louis, Missouri. 8. Department of Emergency Medicine, UT Chattanooga/Erlanger Health Systems, Chattanooga, Tennessee. 9. American College of Emergency Physicians, Washington, DC. 10. Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts. 11. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
PURPOSE: The Centers for Medicare and Medicaid Services (CMS) and the American College of Emergency Physicians (ACEP) developed national quality measures for emergency department (ED) sepsis care. Like care for many conditions, meeting sepsis quality metrics can vary between settings. We sought to examine and compare sepsis care quality in rural vs urban hospital-based EDs. METHODS: We analyzed data from EDs participating in the national Emergency Quality Network (E-QUAL). We collected preliminary performance data on both the CMS measure (SEP-1) and the ACEP measures via manual chart review. We analyzed SEP-1 data at the hospital level based on existing CMS definitions and analyzed ACEP measure data at the patient level. We report descriptive statistics of performance variation in rural and urban EDs. FINDINGS: Rural EDs comprised 58 of the EDs reporting SEP-1 results and 405 rural patient charts in the manual review. Of sites reporting SEP-1 results, 44% were rural and demonstrated better aggregate SEP-1 bundle adherence than urban EDs (79% vs 71%; P = .049). Both urban and rural hospitals reported high levels of compliance with the ACEP recommended initial actions of obtaining lactate and blood cultures, with urban EDs outperforming rural EDs on metrics of IV fluid administration and antibiotics (74% urban vs 60% rural; P ≤ .001; 91% urban vs 84% rural; P ≤ .001, respectively). CONCLUSIONS: Sepsis care at both rural and urban EDs often achieves success with national metrics. However, performance on individual components of ED sepsis care demonstrates opportunities for improved processes of care at rural EDs.
PURPOSE: The Centers for Medicare and Medicaid Services (CMS) and the American College of Emergency Physicians (ACEP) developed national quality measures for emergency department (ED) sepsis care. Like care for many conditions, meeting sepsis quality metrics can vary between settings. We sought to examine and compare sepsis care quality in rural vs urban hospital-based EDs. METHODS: We analyzed data from EDs participating in the national Emergency Quality Network (E-QUAL). We collected preliminary performance data on both the CMS measure (SEP-1) and the ACEP measures via manual chart review. We analyzed SEP-1 data at the hospital level based on existing CMS definitions and analyzed ACEP measure data at the patient level. We report descriptive statistics of performance variation in rural and urban EDs. FINDINGS:Rural EDs comprised 58 of the EDs reporting SEP-1 results and 405 rural patient charts in the manual review. Of sites reporting SEP-1 results, 44% were rural and demonstrated better aggregate SEP-1 bundle adherence than urban EDs (79% vs 71%; P = .049). Both urban and rural hospitals reported high levels of compliance with the ACEP recommended initial actions of obtaining lactate and blood cultures, with urban EDs outperforming rural EDs on metrics of IV fluid administration and antibiotics (74% urban vs 60% rural; P ≤ .001; 91% urban vs 84% rural; P ≤ .001, respectively). CONCLUSIONS:Sepsis care at both rural and urban EDs often achieves success with national metrics. However, performance on individual components of ED sepsis care demonstrates opportunities for improved processes of care at rural EDs.
Authors: Carl T Berdahl; Jeremiah D Schuur; Craig Rothenberg; Kian Samadian; Dhruv Sharma; Nalani Tarrant; Pawan Goyal; Arjun K Venkatesh Journal: J Am Coll Emerg Physicians Open Date: 2020-05-12
Authors: Margaret Greenwood-Ericksen; Neil Kamdar; Paul Lin; Naomi George; Larissa Myaskovsky; Cameron Crandall; Nicholas M Mohr; Keith E Kocher Journal: JAMA Netw Open Date: 2021-11-01