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

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