The following is the summary of “Establishment of SEP-1 national practice guidelines does not impact fluid administration for septic shock patients” published in the December 2022 issue of Emergency medicine by Boccio, et al.
Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1), was adopted in October 2015 by the Centers for Medicare and Medicaid Services as a nationwide quality metric. The goal of SEP-1 is to provide access to high-quality care for patients presenting at varying stages of the sepsis severity continuum. The primary goal of this research was to determine if SEP-1 had an effect on emergency department (ED) fluid management for patients with suspected septic shock. The research involved a 5 retrospective observational study of 470,558 patient contacts at a large metropolitan academic center.
Patients who had blood cultures taken, antibiotics given, and vasopressors started were included in the sample because they met the criteria for septic shock. Based on when they first presented, participants were split into 2 groups (those who presented before November 1, 2015, and those who presented after February 28, 2018). The primary outcome was considered positive if the total volume of fluids given was greater than or equal to the calculated weight-based (≥30 cc/kg) target. The immediate effect of SEP-1 was evaluated using segmented logistic regression analysis, and the long-term trend of fluid volume supplied was compared between the Pre-SEP-1 and Post-SEP-1 groups using a similar method. There were 413 patients in the pre-SEP-1 cohort and 482 patients in the post-SEP-1 group who experienced a septic shock. The weight-based management of fluids did not differ significantly amongst the cohorts. However, immediately after the release of SEP-1, the likelihood of reaching the weight-based goal dropped by 22%, although this change was not statistically significant (log-odds = -0.25, P=0.41).
Compliance appeared to be trending upwards before and after September 1st, with monthly odds ratio increases of 0.005 and 0.018, respectively; however, these increases did not reach statistical significance (log-odds=0.005, P=0.736 and log-odds =0.018, P=0.10). Overall, SEP-1 did not lead to any statistically or clinically significant modifications in fluid volume resuscitation techniques for patients in suspected septic shock. It’s possible that there are better ways to bring about change in the ED context than sweeping regulations. Barriers to fluid administration and other SEP-1 bundle element practice change deserve additional study.
Source: sciencedirect.com/science/article/abs/pii/S073567572200609X
