In October 2015, the Centers for Medicare and Medicaid Services unveiled Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) as a nationwide quality indicator. The goal of SEP-1 was to make it easier to provide patients who appear at different points along the sepsis severity continuum with high-quality care that is prompt, efficient, and effective. For a study, researchers sought to determine if SEP-1 had an effect on provider practice in relation to fluid management of suspected septic shock patients in emergency departments (EDs).
The research involved a 5-year retrospective observational analysis of 470,558 patient contacts at an urban academic institution. Blood cultures were taken, antibiotics were given, and vasopressors were started, which comprised the sample of patients suspected of having septic shock. According to the date of presentation, participants were split into two cohorts: Pre-SEP-1 (May 1, 2013, – August 30, 2015) and Post-SEP-1 (November 1, 2015, – February 28, 2018). Based on whether the total amount of fluids delivered met or exceeded the estimated weight-based (≥30 cc/kg) target, the primary outcome was categorized as a dichotomous variable. SEP-1’s immediate effects were evaluated, and segmented logistic regression analyses were utilized to examine the long-term trend of the fluid amount supplied between the Pre-SEP-1 and Post-SEP-1 groups.
The Pre-SEP-1 and Post-SEP-1 groups, respectively, each had 413 and 482 septic shock patients. In terms of weight-based fluid management, there was no statistically significant difference across the groups. Following the release of SEP-1, the odds of compliance with the weight-based target reduced by 22%, although it was not statistically significant (log-odds = -0.25, P=0.41). Although odds ratios increased by 0.005 and 0.018 per month during the Pre-SEP-1 and Post-SEP-1 periods, respectively, there was no statistically significant difference between these results (log-odds = 0.005, P=0.736, and log-odds = 0.018, P=0.10).
Overall, fluid volume resuscitation techniques for patients with suspected septic shock after SEP-1 did not alter in a way that was clinically or statistically significant. In the ED situation, broad requirements might not be useful instruments for encouraging practice change. It was necessary to do more studies into the factors that prevent practice patterns related to fluid administration and other components of the SEP-1 bundle from changing.
Reference: sciencedirect.com/science/article/pii/S073567572200609X
