Medicine

In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour ...

The death of a pediatric patient with sepsis motivated New York to mandate statewide sepsis treatment in 2013. The mandate included a 1-hour bundle of blood cultures, broad-spectrum antibiotics, and a 20-mL/kg intravenous fluid bolus. Whether completing the bundle elements within 1 hour improves outcomes is unclear. To determine the risk-adjusted association between completing the 1-hour pediatric sepsis bundle and individual bundle elements with in-hospital mortality. Statewide cohort study conducted from April 1, 2014, to December 31, 2016, in emergency departments, inpatient units, and intensive care units across New York State. A total of 1179 patients aged 18 years and younger with sepsis and septic shock reported to the New York State Department of Health who had a sepsis protocol initiated were included. Completion of a 1-hour sepsis bundle within 1 hour compared with not completing the 1-hour sepsis bundle within 1 hour. Risk-adjusted in-hospital mortality. Of 1179 patients ...

BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative network, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality improvement and staff education to participating hospitals. The primary outcome of the evaluation was all-cause risk-adjusted hospital mortality among cases with sepsis per hospital. Sepsis was identified by ICD-10 codes in claims data for sepsis with organ dysfunction or septic shock according to the sepsis-1 definition. To evaluate the effect of the GQNS, the change in outcomes from a retrospective baseline (January 2014 – March 2016) to the intervention phase (April 2016 – June 2018) was compared between the hospitals in the GQNS and the national German diagnosis-related-groups statistics. Tests were conducted by inter...

ImportanceDespite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health Problems (ICD)–coded hospital discharge diagnosis for sepsis identification suffer from limited sensitivity. Also, ICD data do not allow investigation of underlying pathogens and antimicrobial resistance.ObjectivesTo generate reliable epidemiological estimates by linking data from a population-based database to a reference standard of clinical medical record review.Design, Setting, and ParticipantsThis was a retrospective, observational cohort study using a population-based administrative database including all acute care hospitals of the Scania region in Sweden in 2019 and 2020 to identify hospital-treated sepsis cases by ICD codes. From this database, clinical medical records were also selected for review within 6 strata defined by ICD discharge diagnosis (both with and without sepsis diagnosis). Data wer...