April 21, 2021 – UPMC today announced that the first large-scale, multi-hospital evaluation of an “all or none” federal policy intended to improve outcomes in sepsis patients found that the guidelines are a wash.
According to an analysis by University of Pittsburgh School of Medicine clinician-scientists of nearly a dozen hospitals in one academic health system, on average the policy neither helped nor hurt despite significant investments in their implementation.
The findings, reported in the Annals of Internal Medicine, indicate ways the guidelines, known as Severe Sepsis and Septic Shock: Management Bundle, or “SEP-1,” could be built upon and potentially improved.
The Centers for Medicare & Medicaid Services (CMS) implemented SEP-1 in October 2015. For hospitals to be considered compliant, patients must receive a bundle of treatments, including blood cultures, early antibiotics, regular lab tests and IV fluids, and hospitals must collect and report data on their adherence.
Researchers looked at electronic health records (EHR) data on 54,225 visits by adult patients at 11 hospitals of varying sizes in the UPMC system, which served urban, suburban or rural populations. UPMC responded to SEP-1 with several strategies common to hospitals across the U.S., including sepsis alerts, electronic order sets and clinical documentation reminders.
The most significant change across the study period was that clinicians increased their ordering of lactate measurement, which is a test to measure lactic acid in a patient’s blood to determine if they are experiencing low blood flow or low blood oxygen. But the increased testing did not translate to other changes in care delivery or to less deaths overall.