SESSION TYPE: Improving Processes and Outcomes in Adult Critical Care
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: In the US over 2 million patients per year are treated in hospitals with sepsis and 991,900 of these cases are severe sepsis and septic shock. Sepsis, severe sepsis and septic shock are associated with a mortality of 5-20%, 27-40% and 36-47%, respectively and responsible for over $54 billion in Medicare and Medicaid spending. The purpose of this project was to identify Early Sepsis Intervention Strategy (ESIS) compliance and show a reduction in-hospital costs.
METHODS: Retrospective data analysis of 926 patients with severe sepsis and septic shock in an urban academic tertiary care hospital over a 2 year period. ESIS compliance was considered complete when all bundle elements were met. We compared ESIS compliance vs. non-compliance patient groups in relation to demographic data, baseline organ dysfunction (APACHE-II and SOFA) at baseline and over the first 24 hours. In addition mortality, hospital length of stay (LOS), and charges were also compared between groups. Univariate test by the means of chi-square or student’s t-test were used for the statistical analysis.
RESULTS: ESIS compliance was observed in 66% of patients. “Non-compliant” and “compliant” groups were similar in age and gender. APACHEII and SOFA were used as indicators for clinical improvement: APACHE II at 0hrs was worse for the compliant group (20.8vs.23.0, P<0.001) but significantly better at 24hrs (23.6vs.19.6, P 0.0001). Similar results were found for the SOFA score: at 0hrs (7.0 vs.7.9; P<0.01); at 24hrs (8.3vs.6.5, P<0.001). In-hospital mortality for ESIS non-compliant group was 43.6% vs.22.7 % for the compliant group (P <0.001). This difference was also observed at 28days (64.9 %vs.42.3 %, P<0.001). Hospital LOS in the non-compliant group was 20.8days compared to 15.6days in the ESIS compliant group (P<0.001) and hospital charges of $170,619 and $144,835 respectively (P<0.001).
CONCLUSIONS: Adherence to an ESIS not only reduced mortality but also associated health care costs.
CLINICAL IMPLICATIONS: If our institutional results with ESIS compliance are generalized towards Medicare and Medicaid patients with severe sepsis, cost savings of up to $28 billion per year are projected for the United States.
DISCLOSURE: The following authors have nothing to disclose: Jayna Gardner-Gray, Anja Jaehne, Kristine McGregor, Andrew Clark, Samantha Brown, Adam Schlichting, Victor Coba, William Conway, David Nerenz, Emanuel Rivers
No Product/Research Disclosure InformationHenry Ford Hospital, Emergency Medicine, Detroit, MI