CDC releases Get Ahead of Sepsis - 8/31/17
"A national effort to encourage healthcare professionals, patients, and caregivers to prevent infections, be alert to the signs of sepsis, and act fast if sepsis is suspected. Sepsis is the body’s extreme response to an infection. It is life-threatening, and without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death."
Core Measures - 10/01/15
Beginning with hospital inpatient discharges 10/01/15, patients diagnosed with severe sepsis, or septic shock will be part of the population sample for Sepsis Core Measures – Early Management Bundle, Severe Sepsis/Septic Shock.
“Multicenter efforts to promote bundles of care for severe sepsis and septic shock were associated with improved guideline compliance and lower hospital mortality (Ferrer, 2008). Even with compliance rates of less than 30%, absolute reductions in mortality of 4-6% have been noted (Levy, 2010 and Ferrer, 2008). Absolute reductions in mortality of over 20% have been seen with compliance rates of 52% (Levy, 2010). Coba et al. has shown that when all bundle elements are completed and compared to patients who do not have bundle completion, the mortality difference is 14% (2011). Thus, there is a direct association between bundle compliance and improved mortality. Without a continuous quality initiative (CQI), even these compliance rates will not improve and will decrease over time (Ferrer, 2008). Multiple studies have shown that, for patients with severe sepsis, standardized order sets, enhanced bedside monitor display, telemedicine, and comprehensive CQI feedback is feasible, modifies clinician behavior, and is associated with decreased hospital mortality (Thiel, 2009; Micek, 2006; Winterbottom, 2011; Schramm, 2011; Nguyen, 2007; Loyola, 2011).” – Specifications Manual for National Hospital Inpatient Quality Measures Dischages v5.0a
In March, The New England Journal of Medicine published findings from a five year randomized control clinical trial, which enrolled 1,341 patients, on the survival of patients with septic shock who received one of three different groups of treatment (click here for paper). The three groups were defined as follows: First, Early Goal Directed Care involved placing a central-venous catheter to monitor blood pressure and blood oxygen level, administration of IV fluids, vasopressors, dobutamine, or packed red-cell transfusions. Second, Protocolized Standard Care was defined as adequate peripheral venous access, administration of IV fluids and vasoactive agents (to reach a goal for systolic blood pressure and shock index). It recommended packed red-cell fusion only when hemoglobin level was less than 7.5g per deciliter. Third, Standard Care was defined as usual best practice care, with the bed-side providers directing all care. The study found survival of patients with septic shock was statistically the same whether they received Early Goal Directed Care, Protocolized Standard Care or Standard Care.
What does this mean for UCLA's Surviving Sepsis Initiative?
The current Core Measures and DSRIP bundle elements are within the study’s definition for Standard Care at an academic medical center. This includes approved IV antibiotics within 60 minutes of time of presentation, lactates drawn, blood cultures drawn, and IV fluid bolus when indicated. . This study fortifies UCLA’s Surviving Sepsis Initiative and our bundle implementation. Ultimately this study shows the methodology UCLA currently uses has the same survival rate as hospitals which choose to administer invasive procedures such as central venous catheters to patients.