Improving Sepsis Management Through the Emergency Quality Network Sepsis Initiative

Area of Science:

• Emergency Medicine
• Healthcare Quality Improvement
• Sepsis Management

Background:

• Public reporting of the Centers for Medicare & Medicaid Services (CMS) SEP-1 sepsis quality measure lacks real-time data granularity for effective quality improvement (QI).
• The American College of Emergency Physicians (ACEP) Emergency Quality Network (E-QUAL) Sepsis Initiative aimed to aid QI through preliminary SEP-1 score benchmarking for emergency department (ED) patients.

Purpose of the Study:

• To evaluate the anticipatory value of preliminary SEP-1 benchmarking scores from EDs.
• To compare preliminary benchmarking scores with publicly reported CMS SEP-1 performance data.

Main Methods:

• A cross-sectional analysis of QI data from hospital-based EDs participating in the E-QUAL Sepsis Collaborative (2017-2018).
• Semiannual submission of SEP-1 benchmarking scores by participating EDs for comparison with public CMS SEP-1 data.
• Reporting of sepsis-related QI activities by EDs to correlate with SEP-1 performance.

Main Results:

• A weak but statistically significant correlation (r=0.189, p=0.01) was found between E-QUAL benchmarking scores and CMS SEP-1 scores among 220 EDs.
• Mean E-QUAL benchmarking scores (74.1%) were higher than mean CMS scores (57.2%), with 83.2% of sites reporting higher benchmarking scores.
• EDs with lower SEP-1 benchmarking scores reported completing more sepsis-related QI activities.

Conclusions:

• Preliminary benchmarking provides a weak but significant correlation with subsequent public SEP-1 scores.
• ED sepsis care performance may exceed overall hospital performance when ED cases are analyzed separately.
• Separating ED sepsis cases from inpatient cases is recommended for more accurate sepsis quality measurement and QI efforts.