Compliance with SEP-1 guidelines is associated with improved outcomes for septic shock but not for severe sepsis  

作　　者：Shelly NBSloan Nate Rodriguez Thomas Seward Lucy Sare Lukas Moore Greg Stahl Kerry Johnson Scott Goade Robert Arnce 

机构地区：[1]Department of Primary Care,College of Medicine,Kansas City University,2901St.Johns Blvd.,Joplin,MO 64804,USA [2]Department of Quality Improvement,Freeman Health System,Joplin,MO 64804,USA [3]Department of Mathematics,Missouri Southern State University,Joplin,MO 64801,USA [4]Department of Pharmacy,Freeman Health System,Joplin,MO 64804,USA

出　　处：《Journal of Intensive Medicine》2022年第3期167-172,共6页重症医学（英文）

摘　　要：Background: In 2018, the Centers for Medicaid and Medicare Services (CMS) issued a protocol for the treatment of sepsis. This bundle protocol, titled SEP-1 is a multicomponent 3 h and 6 h resuscitation treatment for patients with the diagnosis of either severe sepsis or septic shock. The SEP-1 bundle includes antibiotic administration, fluid bolus, blood cultures, lactate measurement, vasopressors for fluid-refractory hypotension, and a reevaluation of volume status. We performed a retrospective analysis of patients diagnosed with either severe sepsis or septic shock comparing mortality outcomes based on compliance with the updated SEP-1 bundle at a rural community hospital. Methods: Mortality outcome and readmission data were extracted from an electronic medical records database from January 1, 2019, to June 30, 2020. International Classification of Diseases (ICD)-10 codes were used to identify patients with either severe sepsis or septic shock. Once identified, patients were separated into four populations: patients with severe sepsis who met SEP-1, patients with severe sepsis who failed SEP-1, patients with septic shock who met SEP-1, and patients with septic shock who failed SEP-1. A patient who met bundle criteria (SEP-1 criteria) received each component of the bundle in the time allotted. Using chi-squared test of homogeneity, mortality outcomes for population proportions were investigated. Two sample proportion summary hypothesis test and 95% confidence intervals (CI) determined significance in mortality outcomes. Results: Out of our 1122 patient population, 437 patients qualified to be measured by CMS criteria. Of the 437 patients, 195 met the treatment bundle and 242 failed the treatment bundle. Upon comparing the two groups, we found the probable difference in mortality rate between the met(14.87%) and failed bundle(27.69%) groups to be significant(95% CI: 5.28-20.34, P = 0.0013). However, the driving force of this result lies in the subgroup of patients with severe sepsis with septic shock, which show

关 键 词：SEP-1 SEPSIS Early goal-directed therapy Centers for Medicaid and Medicare Services Quality improvement REIMBURSEMENT 

分 类 号：R459.7[医药卫生—急诊医学]