Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement

Abstract

Purpose Sepsis is a common cause of death. The Centers for Medicare and Medicaid Services severe sepsis/septic shock (SEP-1) bundle is focused on improving sepsis outcomes, but it is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and reduced sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and nonreporting hospitals and to measure the association between sepsis QI processes, SEP-1 performance, and sepsis mortality. Materials and Methods This study linked survey data on QI practices from Iowa hospitals to SEP-1 performance data and mortality. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with SEP-1 performance and observed-to-expected sepsis mortality ratios. Results One hundred percent of Iowa's 118 hospitals completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%, P=0.026) and using the case review process to develop sepsis care plans (87% versus 64%, P=0.013). Sepsis QI practices were not associated with increased SEP-1 scores. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality (odds ratio, 0.37; 95% confidence interval, 0.14 to 0.96, P=0.041), and presence of a sepsis committee was associated with lower hospital-specific mortality (observed-to-expected ratio,-0.11; 95% confidence interval,-0.20 to 0.01). Conclusions Hospitals reporting SEP-1 compliance conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.