In the United States, the first-ever sepsis regulation linked to lower mortality rates

Sepsis mortality rates have declined faster than expected in New York State – and faster than in peer states – following the introduction of the first sepsis regulation imposed by the government. State, according to an badysis conducted by researchers at the University of Pittsburgh and published today in JAMA. The policy requires all hospitals in New York to quickly apply certain protocols when there is suspicion of a deadly condition.

This discovery is good news for nearly a dozen other states that, at various stages of adopting similar policies, aim to reduce the number of deaths from sepsis, the leading cause of death among hospitalized patients. . Sepsis is a potentially life-threatening condition that occurs when the body's reaction to infection damages its own tissues and organs.

"Rarely in the United States, we are forcing hospitals to implement specific clinical protocols.Generally, quality improvement is achieved through financial incentives and public reporting," said L & # 39; Lead author Jeremy Kahn, MD, MS, professor in the Department of Critical Care Medicine at Pitt's School. of Medicine and the Department of Policy and Health Management of Pitt's Graduate School of Public Health. "For the first time, state authorities have included in the regulations that hospitals must follow certain evidence-based protocols for sepsis, and our study reveals that, at least in New York, it seemed to work."

Rory's regulations were published by the New York State Department of Health in 2013 after the death of 12-year-old Rory Staunton, following an undiagnosed sepsis. The regulation requires that New York hospitals follow the protocols in case of sepsis, which include the administration of antibiotics within three hours and intravenous fluids within six hours of their hospitalization. Hospitals are also required to regularly train staff to protocols and report membership and clinical outcomes to the state.

Kahn and his team badyzed the records of more than one million sepsis admissions in 509 New York hospitals and four states of sepsis-free control: Florida, Maryland, Mbadachusetts and New Jersey. The team reviewed the dates two years before the adoption of Rory's bylaw and two years later.

In the years before the regulations came into force, 26.3% of people diagnosed with sepsis in New York died while in hospital, compared to 22% in the control states. In accordance with regulations, the sepsis mortality rate in New York dropped from 4.3% to 22%, but the mortality rate only decreased from 2.9% to 19.1% in the United States. witnesses.

After taking into account the characteristics of patients and hospitals, as well as pre-existing sepsis trends in the states, the rate of sepsis deaths in New York was 3.2% lower than in the expected situation. compared to the control States. This comparison was crucial for estimating improvement and differentiating this study from previous work. Sepsis outcomes are known to improve over time – a study that is just beginning in New York would not be able to differentiate the effects of regulation from underlying trends. Since these improvements have occurred faster in New York than in other states, researchers are more confident that regulation is the source.

"Sepsis is a huge burden on the world's health, so developing proven ways to recognize and treat sufferers quickly is a top priority for public health," said lead author Derek Angus, MD, MPH. Professor and Director of Pitt's Department of Critical Care Medicine. and Director of the CRISMA Center for Clinical Research, Investigation and Modeling of Pitt's Acute Disease Systems. "While each state should consider its population and its specific needs when developing regulations, our badysis reveals that policies imposing evidence-based clinical protocols for the rapid recognition and treatment of sepsis save lives. "