Improved hospital mortality rates after the implementation of emergency department sepsis teams

Erin L Simon; Katarina Truss; Courtney M Smalley; Kevin Mo; Caroline Mangira; Jessica Krizo; Baruch S Fertel

doi:10.1016/j.ajem.2021.10.035

Improved hospital mortality rates after the implementation of emergency department sepsis teams

Am J Emerg Med. 2022 Jan:51:218-222. doi: 10.1016/j.ajem.2021.10.035. Epub 2021 Oct 25.

Authors

Erin L Simon¹, Katarina Truss², Courtney M Smalley³, Kevin Mo², Caroline Mangira⁴, Jessica Krizo⁵, Baruch S Fertel⁵

Affiliations

¹ Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA; Northeast Ohio Medical University, Rootstown, OH, USA. Electronic address: SimonE@ccf.org.
² Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA.
³ Cleveland Clinic Emergency Services Institute, Cleveland Clinic Lerner College of Medicine Cleveland, OH, USA.
⁴ Cleveland Clinic Akron General, Department of Research, Akron, OH. USA.
⁵ Emergency Services Institute Cleveland Clinic Foundation, Enterprise Quality and Safety, Cleveland Clinic Lerner College of Medicine, Cleveland, OH. USA.

PMID: 34775195
DOI: 10.1016/j.ajem.2021.10.035

Abstract

Introduction: Sepsis is a leading cause of mortality with more than 700,000 hospitalizations and 200,000 deaths annually in the United States. Early recognition of sepsis is critical for timely initiation of treatment and improved outcomes. We sought to evaluate. in-hospital mortality rates of patients diagnosed with sepsis before and after implementation of emergency department (ED) sepsis teams.

Methods: This was a retrospective study of adult patients seen at a tertiary care ED diagnosed with sepsis and severe sepsis. Pre-implementation study time frame was 5/1/2018-4/30/2019 and post-implementation was 11/1/2019-9/30/2020. A six-month washout period was utilized after implementation of ED-based sepsis teams. Indications for sepsis team activation were: two systemic inflammatory response syndrome (SIRS) criteria with suspected infection or two SIRS with confirmed infection during workup. Categorical variables are presented as frequencies and percentages. Continuous variables are presented as mean and standard deviation or median and quartiles depending on distribution. Multiple logistic regression compared mortality rates pre- and post-implementation while controlling for Charlson comorbidity index. Secondary objectives included comparing time metrics pre- and post-implementation. Student t-tests compared normally distributed variables and Wilcoxon rank sum tests compared non-normally distributed variables.

Results: There were 1188 participants included in the study; 553 before implementation of sepsis teams and 635 after implementation. Mean age of participants was 64 years. Patients were 74.7% white and 22.6% black. Medicare was the most common health insurance (59%). Mortality rates were significantly lower post-implementation of sepsis teams compared to pre-implementation with an adjusted odds ratio of 0.472, (95%CI, 0.352-0.632). ED LOS (95%CI (-67.2--11.3), hospital LOS (95%CI, -1.0--0.002) and time to lactic acid (95%CI, -10.0- -3.0) and antibiotics (95%CI, -29.0--11.0) were all significantly lower after implementation.

Conclusion: Implementation of ED sepsis teams decreased inpatient hospital mortality rates, ED length of stay and hospital length of stay.

Keywords: Emergency department; Mortality; sepsis; sepsis team.

MeSH terms

Aged
Aged, 80 and over
Emergency Service, Hospital / organization & administration*
Female
Hospital Mortality*
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Ohio
Process Assessment, Health Care
Quality Improvement / organization & administration*
Retrospective Studies
Sepsis / diagnosis*
Sepsis / mortality
Sepsis / therapy
Systemic Inflammatory Response Syndrome / diagnosis*
Systemic Inflammatory Response Syndrome / mortality
Systemic Inflammatory Response Syndrome / therapy