Association Between Implementation of the Severe Sepsis and Septic Shock Early Management Bundle Performance Measure and Outcomes in Patients With Suspected Sepsis in US Hospitals

Importance: In October 2015, the Centers for Medicare 60 530 51.5% men and 56 980 48.5% women) with suspected sepsis. Lactate testing rates increased from 55.1% (95% CI, 53.9%-56.2%) in Q4 of 2013 to 76.7% (95% CI, 75.4%-78.0%) in Q4 of 2017, with a significant level change following SEP-1 implementation (odds ratio OR, 1.34; 95% CI, 1.04-1.74). There were increases in use of anti-MRSA antibiotics (19.8% 95% CI, 18.9%-20.7% in Q4 of 2013 to 26.3% 95% CI, 24.9%-27.7% in Q4 of 2017) and antipseudomonal antibiotics (27.7% 95% CI, 26.7%-28.8% in Q4 of 2013 to 40.5% 95% CI, 38.9%-42.0% in Q4 of 2017), but these trends preceded SEP-1 and did not change with SEP-1 implementation. Unadjusted short-term mortality rates were similar in the pre-SEP-1 period (Q4 of 2013 through Q3 of 2015) vs the post-SEP-1 period (Q1 of 2016 through Q4 of 2017) (20.3% 95% CI, 20.0%-20.6% vs 20.4% 95% CI, 20.1%-20.7%), and SEP-1 implementation was not associated with changes in level (OR, 0.94; 95% CI, 0.68-1.29) or trend (OR, 1.00; 95% CI, 0.97-1.04) for risk-adjusted short-term mortality rates. Conclusions and Relevance: In this cohort study, SEP-1 implementation was associated with an immediate increase in lactate testing rates, no change in already-increasing rates of broad-spectrum antibiotic use, and no change in short-term mortality rates for patients with suspected sepsis. Other approaches to decrease sepsis mortality may be warranted.