• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Do Mandated Sepsis Procedures Reduce Sepsis-Related Deaths?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • In 2013 New York State mandated that hospitals implement evidence-based sepsis protocols including the following elements
    • Antibiotics within 3 hours
    • IV resuscitation within 6 hours for those with hypoperfusion
    • Staff training
    • Track and report data to the state government
  • Kahn et al. (JAMA, 2019) evaluated whether mandating sepsis procedures improves and the outcomes  

METHODS:

  • Retrospective cohort study
  • Participants with sepsis diagnosis
    • Hospitalized patients in New York State
    • Control populations from 4 control states (Florida, Maryland, Massachusetts, and New Jersey)
  • Data collection
    • All-payer hospital discharge data (2011 to 2015) and a comparative interrupted time series analytic approach
    • Adjustments were made for patient demographics, hospital characteristics, temporal trends and seasonal changes
  • Exposures
    • Pre-protocol implementation time period: Hospitalization for sepsis prior to January 1, 2011-March 31, 2013
    • Post-protocol implementation time period: Hospitalization for sepsis from April 1, 2013-September 30, 2015
  • Primary outcome
    • 30-day in-hospital mortality
  • Secondary outcomes
    • ICU admission rates
    • Central venous catheter use
    • Clostridium difficile infection rates
    • Hospital length of stay

RESULTS:

  • 1,012,410 sepsis admissions | 509 hospitals
  • Mean age (SD): 69.5 (16.4) years | 47.9% were female
  • Sepsis admissions
    • New York State
      • Before regulation: 139,019 patients
      • After regulation: 186,767 patients
    • Control states 
      • Before regulation: 289,255 patients
      • After regulation: 397,399 patients
  • Unadjusted 30-day in-hospital mortality
    • New York State
      • Before regulation: 26.3%
      • After regulation: 22.0%
    • Control States
      • Before regulation: 22.0%
      • After regulation: 19.1%
  • Adjusted 30-day mortality rate
    • Mortality was significantly reduced following sepsis protocol implementation in New York State (P=.02)
  • Adjusted absolute mortality (in the last quarter covered by the study)
    • 3.2% lower than expected in the New York vs control states (95% CI, 1.0% to 5.4; P = .004)
  • Regulations were significantly associated with the following
    • Relative decrease in hospital length of stay (P = .04)
    • Relative decrease in the C difficile infection rate (P < .001)
    • Relative increase in central venous catheter use (P = .02)
  • No significant difference was seen in ICU admission rates (P = .09)

CONCLUSION:

  • The authors acknowledge that results may not be generalizable to other states
  • However, implementation of an evidence-based sepsis-protocol was associated with reduced sepsis related deaths

Learn More – Primary Sources:

Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Does Intrapartum Fever Really Predict Neonatal Sepsis?
What is the Best Practices Prevention Bundle for Post Cesarean Infection?
Which Resuscitation Strategy is Best When Treating Septic Shock?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site