Table 2.
Differences in Unadjusted Process Measures After SEP-1*
| Variable | Q3 2015 (Before SEP-1), Estimate (95% CI), % | Q4 2017 | Estimated Difference Between Expected and Observed in Q4 2017 (Effect of SEP-1) | ||
|---|---|---|---|---|---|
| Expected (Without SEP-1), Estimate (95% CI), % | Observed (With SEP-1), Estimate (95% CI), % | ||||
| Estimate (95% CI), percentage points | P Value | ||||
| All patients | |||||
| Antibiotics within 3 h | 43.6 (42.5 to 44.7) | 45.1 (42.5 to 47.7) | 49.8 (48.6 to 51.0) | 4.7 (1.9 to 7.6) | 0.001 |
| Lactate within 3 h | 33.1 (32.0 to 34.1) | 46.5 (43.6 to 49.3) | 70.2 (69.1 to 71.2) | 23.7 (20.7 to 26.7) | <0.001 |
| 30 mL/kg IV fluid within 3 h | 8.5 (7.9 to 9.1) | 9.9 (8.2 to 11.6) | 13.2 (12.4 to 14.0) | 3.4 (1.5 to 5.2) | <0.001 |
| Repeat lactate within 6 h† | 9.4 (8.4 to 10.5) | 9.6 (6.9 to 12.3) | 27.0 (25.7 to 28.2) | 17.4 (14.4 to 20.4) | <0.001 |
| Vasopressors within 6 h‡ | 17.1 (15.4 to 18.8) | 18.2 (14.0 to 22.5) | 17.0 (15.1 to 19.0) | −1.2 (−5.9 to 3.5) | 0.61 |
| Patients with a mean arterial pressure <65 mm Hg in first 6 h | |||||
| Antibiotics within 3 h | 50.4 (48.1 to 52.7) | 54.1 (48.7 to 59.5) | 57.8 (55.3 to 60.4) | 3.7 (−2.2 to 9.7) | 0.22 |
| Lactate within 3 h | 50.7 (48.4 to 52.9) | 65.0 (60.0 to 70.0) | 84.0 (82.2 to 85.8) | 19.0 (13.7 to 24.2) | <0.001 |
| 30 mL/kg IV fluid within 3 h | 20.7 (18.9 to 22.6) | 24.9 (19.8 to 30.0) | 32.1 (29.6 to 34.5) | 7.2 (1.5 to 12.8) | 0.013 |
| Repeat lactate within 6 h† | 15.7 (13.4 to 18.0) | 17.6 (11.4 to 23.7) | 40.1 (37.2 to 42.9) | 22.5 (15.7 to 29.3) | <0.001 |
| Vasopressors within 6 h‡ | 17.1 (15.4 to 18.8) | 18.2 (14.0 to 22.5) | 17.0 (15.1 to 19.0) | −1.2 (−5.9 to 3.5) | 0.61 |
| Patients requiring vasopressors | |||||
| Antibiotics within 3 h | 65.7 (61.0 to 70.4) | 72.7 (62.7 to 82.7) | 71.0 (65.8 to 76.1) | −1.7 (−13.0 to 9.5) | 0.76 |
| Lactate within 3 h | 75.1 (70.9 to 79.3) | 85.0 (78.3 to 91.8) | 91.5 (88.4 to 94.5) | 6.4 (−1.0 to 13.8) | 0.088 |
| 30 mL/kg IV fluid within 3 h | 34.0 (29.2 to 38.9) | 42.6 (29.8 to 55.4) | 45.6 (40.0 to 51.2) | 3.0 (−11.0 to 16.9) | 0.68 |
| Repeat lactate within 6 h† | 31.3 (26.1 to 36.5) | 40.2 (26.0 to 54.5) | 60.5 (54.8 to 66.1) | 20.2 (4.9 to 35.6) | 0.009 |
IV = intravenous; Q = quarter; SEP-1 = Severe Sepsis and Septic Shock Early Management Bundle.
*
The table shows the effect of SEP-1 on processes of care, illustrated as projected differences in expected rates in Q4 2017, two years after SEP-1 implementation.
†
Indicates a repeat lactate measurement within 6 h of suspected infection, when the initial lactate level is greater than 2 mmol/L.
‡
Indicates vasopressor initiation within 6 h of initial hypotension. The results are identical between the overall cohort and the hypotensive cohort because patients without hypotension were by definition excluded in the regression.