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Sepsis Push Reports Include Demographics, COVID Patients

Sepsis Push Reports Include Demographics, COVID Patients

For the last two years, the Michigan Value Collaborative (MVC) Coordinating Center has offered a sepsis service line developed in partnership with the Michigan Hospital Medicine Safety Consortium (HMS). In conjunction with this work, reports customized to each member hospital are distributed each year. The most recent iteration shared with members this week features several updates from the 2021 versions.

A new patient population snapshot table is one new feature that the MVC Coordinating Center added in order to integrate its demographic data. These tables (see Figure 1 for a sample table of a blinded acute-care hospital) provide each hospital with demographics for their sepsis patient population, including race, mean age, top patient zip codes, the most frequent and average number of comorbidities, the proportion of dual-eligible patients, and the proportion of patients with a confirmed diagnosis of COVID-19. Furthermore, this data is stratified by payer, providing additional insights into specific groups of patients.

Figure 1.

The inclusion of COVID-positive patient percentages is an important statistic since this iteration of the sepsis push report includes COVID patients, whereas the Coordinating Center removed these patients in previous versions. This final row of the patient population snapshot table will help hospitals understand the extent to which their data is driven (or not) by patients with a confirmed COVID diagnosis code. Across the collaborative, 90-day total episode payments increased in 2020, which can likely be attributed to episodes with a COVID diagnosis; however, the 2020 average is not much higher than the average from 2018 through early 2019 (see Figure 2). Since the COVID-19 pandemic hit regions of Michigan at different times, regional comparisons for select measures will be particularly useful in understanding one’s data. Different versions of the report were created for acute-care and critical access hospitals, which allowed for tailored comparison groups.

Figure 2.

The complete report compares MVC hospitals on 90-day risk-adjusted total episode payments, inpatient length of stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality and discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, and Medicaid.

In addition to continuing to offer its sepsis push reports, the MVC Coordinating Center also offers a bimonthly sepsis workgroup. The next workgroup will take place on Thursday, May 26 from 2-3 p.m., and will feature a presentation about successes in sepsis-bundle compliance. Register today to join the MVC Coordinating Center for this presentation and discussion.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. We are also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at michiganvaluecollaborative@gmail.com.

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2021 Surviving Sepsis Campaign Guidelines Reviewed at Workgroup

2021 Surviving Sepsis Campaign Guidelines Reviewed at Workgroup

On December 7, 2021, the Michigan Value Collaborative (MVC) held its bi-monthly virtual workgroup on sepsis featuring Dr. Hallie Prescott, Associate Professor at Michigan Medicine and the physician lead on the Michigan Hospital Medicine Safety Consortium (HMS) Sepsis Initiative. For this MVC and HMS co-sponsored workgroup, Dr. Prescott presented Updates in Sepsis: What is new in 2021 SSC Guidelines. Dr. Prescott is a pulmonary and critical care medicine specialist, and she practices clinically in the intensive care units at the University of Michigan Health and Ann Arbor Veterans Affairs hospitals. She is co-chair of the Surviving Sepsis Campaign Adult Guidelines and a council member of the International Sepsis Forum.

The workgroup began with an introduction to the International Surviving Sepsis Campaign (SSC) guidelines and bundles, which are resources and implementation tools used to reduce sepsis and septic shock worldwide. The SSC Guidelines were originally published in 2004 and have been updated every four years, with the most recent edition being published in October 2021. A large panel of experts collaborates to evaluate the evidence and make recommendations (scaled by the strength of recommendation). Since their initial publication, health systems from the United States to Spain have used the SSC guidelines and tools to improve sepsis and septic shock care and outcomes.

Dr. Prescott’s presentation describing the SSC 2021 Adult Guidelines highlighted several recommendations and detailed the reasoning behind some of the changes made since 2016. The highlighted guidelines included recommendations for infection (antibiotic timing, use of antimicrobials) (see Figure 1), hemodynamics (resuscitative fluids, vasopressor timing), ventilation (ECMO), and additional therapies (IV corticosteroids, IV Vitamin C). In addition, a new section for long-term outcomes (see Figure 2) was also added to the newest guidelines and reviewed during the workgroup, addressing patient education, health and social screenings, and post-discharge follow-up. Out of all the discussed recommendations, the MVC and HMS members in attendance were most interested in antibiotic use, resuscitative fluids, central line use, and treatment prioritization.

Figure 1.

Figure 2.

The updated SSC Guidelines offer informative and valuable recommendations that can be used to improve sepsis care and outcomes. If you were unable to attend the workgroup or are simply interested in reviewing the presentation and discussion, a recording of the workgroup is available here. To read the full published SSC 2021 Adult Guidelines and review additional resources, click here.

The MVC Coordinating Center is interested in hearing how your organization has utilized the SSC 2021 Adult Guidelines to improve sepsis care and outcomes. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.