National Healthcare Quality and Disparities Report
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- Antibiotics (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedScott Scott, Kempe A, Bajaj L
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Researchers sought to identify barriers and facilitators to pediatric sepsis care in general emergency departments (EDs), including care processes, the role of guidelines, and incentivized metrics. They interviewed medical directors, nurse managers, and quality coordinators. They found that leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. Leaders universally sought direct support from their nearest children's hospitals and actionable guidelines.
AHRQ-funded; HS025696.
Citation: Scott Scott, Kempe A, Bajaj L .
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Ann Emerg Med 2022 Oct;80(4):347-57. doi: 10.1016/j.annemergmed.2022.05.030..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Guidelines, Evidence-Based Practice
Greenwald E, Olds E, Leonard J
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
The authors sought to describe the rate of guideline-concordant care, and hypothesized that guideline-concordant care in community pediatric emergency care settings would be associated with decreased hospital length of stay (LOS). They found that guideline-concordant care was not associated with hospital LOS. The elements that drove overall concordance were timely recognition, vascular access, and timely antibiotics. Emergency care for pediatric sepsis in the community settings studied was concordant with guidelines in only 24% of the cases. They recommended future study to evaluate additional drivers of outcomes and ways to improve sepsis care in community emergency care settings.
AHRQ-funded; HS025696.
Citation: Greenwald E, Olds E, Leonard J .
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
Pediatr Emerg Care 2021 Dec;37(12):e1571-e77. doi: 10.1097/pec.0000000000002120..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Guidelines, Evidence-Based Practice
Klompas M, Osborn TM, Rhee C
Who owns sepsis?
In this Ideas and Opinions article, the authors discuss applying to sepsis guidelines that are already in place for other conditions. They indicate that other time-critical diagnoses have evolved triaging systems to inform the urgency and intensity of therapy, and that sepsis can evolve similarly, where potentially infected patients with worrisome signs or comorbidities, such as hypotension, altered mental status, or immunosuppression, are managed with one level of urgency and intensity and less severely ill patients are managed with another.
AHRQ-funded; HS025008.
Citation: Klompas M, Osborn TM, Rhee C .
Who owns sepsis?
Ann Intern Med 2020 Feb 4;172(3):210-11. doi: 10.7326/m19-2966..
Keywords: Sepsis, Guidelines, Diagnostic Safety and Quality, Critical Care
Trent SA, Jarou ZJ, Havranek EP
Variation in emergency department adherence to treatment guidelines for inpatient pneumonia and sepsis: a retrospective cohort study.
Evidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. The objectives of this study were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence.
AHRQ-funded; HS022400.
Citation: Trent SA, Jarou ZJ, Havranek EP .
Variation in emergency department adherence to treatment guidelines for inpatient pneumonia and sepsis: a retrospective cohort study.
Acad Emerg Med 2019 Aug;26(8):908-20. doi: 10.1111/acem.13639.
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Keywords: Emergency Department, Evidence-Based Practice, Guidelines, Inpatient Care, Pneumonia, Sepsis
Kahn JM, Davis BS, Yabes JG
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
The purpose of this study was to evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. Results showed that, in New York State, mandated protocolized sepsis care was associated with a greater decrease in sepsis mortality compared with sepsis mortality in control states (Florida, Maryland, Massachusetts, and New Jersey) that did not implement sepsis regulations. The authors add that, because baseline mortality rates differ between New York and the comparison states, it is uncertain whether these findings will be generalizable to other states.
AHRQ-funded; HS025146.
Citation: Kahn JM, Davis BS, Yabes JG .
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
JAMA 2019 Jul 16;322(3):240-50. doi: 10.1001/jama.2019.9021..
Keywords: Guidelines, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality, Outcomes, Policy, Sepsis
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Rhee C, Brown SR, Jones TM
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
This study compared sepsis ‘time zero’ and CMS SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 out of 80 cases, and the perceived pass rates ranged from 9 to 19 out of 80 cases (23%). The authors conclude that this variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
AHRQ-funded; HS025008.
Citation: Rhee C, Brown SR, Jones TM .
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
Infect Control Hosp Epidemiol 2018 Aug;39(8):994-96. doi: 10.1017/ice.2018.134..
Keywords: Guidelines, Quality of Care, Quality Measures, Sepsis
Kessler DO, Walsh B, Whitfill T
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
The authors sought to measure and compare adherence to pediatric sepsis guidelines across a spectrum of emergency departments. They found that among 47 teams across 24 emergency departments, adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. They concluded that only composite team experience level of the providers was associated with improved guideline adherence.
AHRQ-funded; HS020286.
Citation: Kessler DO, Walsh B, Whitfill T .
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
J Emerg Med 2016 Mar;50(3):403-15.e1-3. doi: 10.1016/j.jemermed.2015.08.004.
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Keywords: Emergency Department, Disparities, Guidelines, Children/Adolescents, Sepsis
Kramer RD, Cooke CR, Liu V
Variation in the contents of sepsis bundles and quality measures. a systematic review.
The researchers sought to determine the degree of agreement on component elements of sepsis bundles and the associated timing goals for completion of each element. They also evaluated the amount of variation between metrics associated with bundles. They found that no bundle included metrics evaluating timeliness or completeness of sepsis recognition. Also, there was a lack of consensus on component elements and timing goals across highly recognized sepsis bundles.
AHRQ-funded; HS020672.
Citation: Kramer RD, Cooke CR, Liu V .
Variation in the contents of sepsis bundles and quality measures. a systematic review.
Ann Am Thorac Soc 2015 Nov;12(11):1676-84. doi: 10.1513/AnnalsATS.201503-163BC.
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Keywords: Sepsis, Mortality, Guidelines, Antimicrobial Stewardship, Outcomes