Sepsis Diagnostic Excellence and its Association with Mortality in Adults with Potential Infection

Area of Science:

• Clinical Medicine
• Healthcare Management
• Patient Safety

Background:

• Diagnostic uncertainty in sepsis leads to undertreatment (delayed antibiotics) and overtreatment (unnecessary antibiotics).
• This uncertainty impacts patient outcomes and healthcare resource utilization.
• Hospitals with high performance in managing both undertreatment and overtreatment were hypothesized to have better patient outcomes.

Purpose of the Study:

• To evaluate the association between hospital performance in sepsis diagnostic accuracy and patient outcomes.
• To identify hospitals with 'Diagnostic Excellence' (DxEx) by minimizing both undertreatment and overtreatment.

Main Methods:

• Retrospective cohort study of 152,779 adult patients across 20 hospitals (2022-2024).
• Hospital performance assessed using risk-standardized rates (RSR) for sepsis undertreatment and overtreatment.
• DxEx defined as top-tertile performance in one measure and not bottom-tertile in the other.

Main Results:

• Four hospitals achieved DxEx status.
• DxEx hospitals were associated with lower odds of mortality or hospice discharge (aOR=0.61).
• Patients at DxEx hospitals experienced greater hospital-free days (aDiff=0.59) and reduced length of stay (aDiff=-1.20).

Conclusions:

• Jointly minimizing sepsis undertreatment and overtreatment is linked to improved patient outcomes.
• Reducing diagnostic error is crucial for enhancing sepsis care and patient results.
• These findings emphasize the importance of optimizing sepsis diagnosis for better healthcare delivery.