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1470: IDENTIFICATION AND MANAGEMENT OF EARLY SEPSIS AT AN ACADEMIC MEDICAL CENTER WHO DOES IT BETTER?

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: In October 2015, the Centers for Medicare and Medicaid Services implemented severe sepsis (SS) and septic shock (SSh) core measures. This study compared compliance to the measures between ED patients and inpatients (IP). Secondary objectives included compliance to each bundle component, risk factors for non-compliance, hospital and ICU length of stay (LOS), 30-day mortality, and antibiotic initiation within one hour of presentation. Methods: Single-center, retrospective cohort study of patients with ICD code of SS and SSh January 1 – June 30, 2016. Patients were excluded for age < 18 years, transfer from outside hospital, death within 6 hours of admission or admission to hospice. Data collected included demographics, and 3 and 6-hour bundle components. Statistical analysis was performed with SPSS. Nominal data were analyzed using either Fisher’s exact test or X2 test and continuous data was reported using student t test or Mann– Whitney U test. Results: 271 encounters were screened; 121 were excluded. 150 remaining subjects were distributed in a 2:1 ratio between ED and IP, respectively. The median age was 63.4 years; median APACHE II score was 15; and 59.2% were male. For SS overall 3-hour bundle compliance was 60.6% in ED vs. 34 % in IP (P = 0.003); and overall 6-hour bundle compliance was 51% in ED vs. 25 % in IP (P = 0.046). There were no differences in 3 or 6-hour bundle compliance for SSh. Comparing individual components, only the initial and repeated lactate rates were different: ED 78.8% vs. 46% IP (P < 0.001), and ED 51% vs. 25% IP (P = 0.046). Hospital and ICU LOS was significantly shorter in the ED arm. Antibiotic initiation in one hour occurred more often in the IP arm (56% vs. 10.6%; P = 0.001). 30-day mortality was not different. Conclusions: In this study, core measure compliance is higher when sepsis presents in the ED. Utilizing such data will guide targeted efforts for improvement of compliance with sepsis bundles.