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Abstract
Background In 2018, Medicare began public reporting of hospital compliance with Sepsis and Septic Shock Early Management (SEP-1) bundle. We queried whether a relationship between SEP-1 bundle compliance, hospital size, and global measures of quality exists.
Objectives To determine the relationship between SEP-1 bundle compliance and hospital size, composite complication rate (PSI-90), average length of stay (ALOS) and hospital readmission rate.
Methods Data was obtained from Medicares Hospital Compare online database and The American Hospital Directory. Records missing SEP-1, complications, and discharge data were excluded. Pearson correlation, controlling for staffed beds, and an independent t-test were used for analysis.
Results A total of 2796 hospitals met inclusion criteria. An increased SEP-1 score was negatively associated with PSI-90 (r=−0.103, p<0.001), staffed bed number (r=−0.114, p<0.001), and ALOS (r=−0.118, p<0.001). There was no association with 30 day readmission rate (p=0.480). PSI-90 and ALOS remained significantly correlated with SEP-1 while adjusting for staffed beds. Figures 1 to 4 show independent t-test results relating SEP-1 scores to higher – and lower-performing hospitals on each of the indicated quality measures.
SEP-1 bundle compliance scores by number of staffed beds. SEP-1 bundle compliance scores between hospitals with number of staffed beds in the bottom 50th percentile (n=1498) and top 50th percentile (n=1498). Smaller hospitals, measured by number of staffed beds, had statistically significant higher SEP-1 bundle compliance score (50.95±20.29%) compared to larger hospitals (47.26±18.50%), p<0.001.
SEP-1 bundle compliance scores by composite complication rate. SEP-1 bundle compliance scores between hospitals with composite complication rates in the bottom 50th percentile (n=1463) and top 50th percentile (n=1371). Hospitals with lower composite complication rates had statistically significant higher SEP-1 bundle compliance score (50.97±19.80%) compared to hospitals with higher composite complication rates (47.30±18.09%), p<0.001
SEP-1 bundle compliance scores by average length of stay. A) SEP-1 bundle compliance scores between hospitals with average length of stay in the bottom 50th percentile (n=1482) and top 50th percentile (n=1483). Shorter average length of stay has statistically significant higher SEP-1 bundle compliance (51.23±19.69%) compared to longer average length of stay (47.05±19.14%), p<0.001. B) Average length of hospital stay between SEP-1 bundle compliance scores in the bottom 50th percentile (n=1484) and top 50th percentile (n=1481). Lower SEP-1 bundle compliance score has statistically significant longer average length of stay (4.46±1.33 days) compared to shorter average length of stay (4.17±1.23 days), p<0.001
Conclusions Higher performance on SEP-1 compliance is associated with lower composite complication rate and shorter length of stay. The inverse relationship between SEP-1 compliance and hospital size may reflect the challenges associated with implementation of new protocols in large, complex hospitals. While this study does not establish a causal relationship, the ability of hospitals to successfully implement SEP-1 may suggest a higher level of overall operational excellence.
Pearson correlations of SEP-1 bundle compliance versus hospital complications and quality, controlling for number of staffed beds