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Sepsis deaths declined in the 2 years following the implementation of the state's mandate, requiring hospitals to track sepsis case series and report patient outcomes, according to a published study online September 7th. American Journal of Respiratory and Critical Care Medicine.
The results of the study demonstrate "improved care for patients with sepsis, as evidenced by increased compliance with performance metrics and a decrease in risk-adjusted mortality over the first two years. years of initiative. Substantially changed care, "Mitchell M. Levy, MD, of the Pulmonary Division, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School at Brown University, Providence, Rhode Island, and his colleagues write.
The mandate required that hospitals develop and submit for approval evidence-based clusters of sepsis care, as well as reports on treatment of infections and patient mortality. Hospitals were allowed to customize the groups for their specific hospitals, but they had to include the following:
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Batch of 3 hours (all patients with severe sepsis): administration of antibiotics and measurement of lactate levels within 3 hours after diagnosis of sepsis, with collection of blood cultures before the administration of. antibiotics
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6-hour group (for septic shock: systolic blood pressure <90 mmHg or lactate ≥ 4 mmol / L): intravenous bolus (300 cc / kg), vasopressors for refractory hypotension, remeasurement of lactate levels within 6 hours after onset package
To investigate the impact of the sepsis initiative, researchers analyzed data on 91,357 adult patients with sepsis and septic shock (median age, 71 years) observed in 183 hospitals in April 2014 to June 2016.
The results showed that for 81.3% of these patients (n = 74,293), a sepsis bundle was triggered. The use of the 3-hour plan went from 53.4% to 64.7% (P <0.001) and use of the 6-hour series in eligible patients increased from 23.9% to 30.8% (P <0.001).
Among patients who received the sepsis cluster, risk-adjusted mortality decreased from 28.8% before the initiative to 24.4% after the initiative (P <0.001).
This translates into an absolute decrease of 4.4% and a 15% relative decrease in risk-adjusted mortality over the study period.
Hospitals that were more respectful of sepsis had lower mortality than those with less adherence. The risk-adjusted mortality for the least compliant hospitals was 29.8% compared to 23.5% for the most compliant hospitals. In addition, for more respected hospitals, lengths of stay were shorter.
Although the study can not prove that sepsis bundles directly improve mortality, the authors write that "there is reason to believe that this might be the case", especially because initiation and completion of the
History of the sepsis mandate
In 2013, the State of New York launched the nation's first public statement initiative for sepsis. The New York State initiative was prompted by the death of 12-year-old Rory Staunton, who died of an undiagnosed sepsis after developing a scab infection. The media, as well as advocacy groups, the Centers for Medicare & Medicaid Services, and the governor of New York have drawn attention to this issue.
Governor Andrew Cuomo and then Health Commissioner Nirav Shah responded to Rory's preventable death by making it mandatory to report the sepsis process and its results, with the goal of improving diagnosis and management of sepsis ".
"The reason the state adopted these particular sets is that our group had published evidence showing that there was a strong association between the observance of these interventions and the improvement of survival in sepsis, "he added.
"The New York State Sepsis Initiative provides strong evidence that compliance with sepsis performance measures is associated with better survival in these critically ill patients," explained Levy. "At least in sepsis, our study strongly supports the value of the public release of the results."
The study was funded by the New York Department of Health. One or more authors report receiving funding from one or more of the following organizations: the National Institutes of Health, the research program initiated by the Veterans Affairs Health Services Researchers, and the Canadian Institutes of Health. ; IPRO.
Am J Respir Crit Care Med. Posted online September 7, 2018. Summary
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