Sepsis Early Management Bundle

What are we measuring and why?

Sepsis is a life-threatening and progressive inflammatory response to infection. It is a leading cause of inpatient mortality, accounting for more than 1.5 million hospitalizations and 250,000 deaths in the United States each year. While there is no simple test to diagnose sepsis or single therapy to reverse its harmful effects, research has demonstrated that rapid identification and treatment can save lives and reduce the long-term impact on survivors, which has spurred regulatory efforts to protocolize care.   

How are we doing and how do we compare to best practice?

In 2015, the Centers for Medicare and Medicaid Services (CMS) launched a complex new composite measure to evaluate hospitals’ adherence with time-based diagnostic and treatment recommendations for sepsis. The CMS Severe Sepsis and Septic Shock Bundle (SEP-1) measures several clinical processes, including initial/repeat lactate collection, blood culture collection, repeat volume status/tissue perfusion assessment, and the initiation of antibiotic, crystalloid fluid, and vasopressor treatment. MGH reported a 37% compliance rate in 2017, compared to the national average of 50%. Early data for 2018 show that our performance is steadily improving over time.   

  • Current Scores
  • Scores Over Time
  • Higher values are better
50% 75% 37%

MGH Source: Hospital administrative data and chart review
Comparison Group Source: CMS/TJC National Hospital Quality Measures

MGH: Jan - Dec 2017
CMS: Jan - Dec 2017

30 37 50 75

MGH Source: Hospital administrative data and chart review
Comparison Group Source: CMS/TJC National Hospital Quality Measures



What are we doing to improve?

MGH is committed to improving the detection and treatment of sepsis. We have ramped up our staff education to build institutional knowledge around the condition, treatment expectations, and resources to support safe, effective sepsis care. One such resource is a Partners-wide alert system that analyzes elements in the electronic health record, such as vital signs and cultures, to flag patients who meet the criteria for possible sepsis and septic shock. It provides real-time decision support mapped to the clinical stages in the Partners Sepsis Pathway, our gold-standard for sepsis care. The alert not only helps bring possible sepsis our clinicians’ attention, but includes shortcuts to quickly document a sepsis diagnosis and prescribe standard care processes (when appropriate), ensuring that all members of the care team are aware of the patient’s condition and that appropriate actions are being taken. Overall, these interventions are strengthening our clinical response and communication tactics around sepsis.

 

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