New York Mandated Sepsis Reporting, Care Protocols. It Worked.

An analysis of New York State's first-in-the-nation mandated reporting and care protocols for sepsis shows improvements in care, even without financial incentives.

The country's first state-mandated reporting initiative for sepsis has increased compliance with sepsis care bundles and helped reduce mortality rates for the deadly infection, recent research shows.

In 2013, the state of New York launched a public reporting initiative for sepsis that required adherence to care bundles for patients with severe sepsis and septic shock. The research, which examined data from April 2014 to June 2016, was published in the Journal of Respiratory and Critical Care Medicine.

"This study demonstrates the association between state-wide mandated public reporting of compliance with sepsis performance measures and outcomes, improving care, and decreasing mortality," the researchers wrote.

The research features 91,357 hospitalizations from 183 hospitals. The sepsis care bundles specify interventions for sepsis patients three hours and six hours after diagnosis. For example, the three-hour bundle includes drawing blood cultures, administration of antibiotics, and measuring of blood lactate levels.

The research has several key findings:

• Of the 91,357 sepsis patients, 81.3% were treated under a sepsis care bundle
   
• Compliance with the three-hour care bundle increased from 53.4% to 64.7%
   
• Compliance with the six-hour care bundle increased from 23.9% to 30.8%
   
• Risk-adjusted mortality decreased from 28.8% to 24.4%
   
• Increased care bundle compliance was associated with shorter length of stay

"This study … demonstrates improved care for patients with sepsis as evidenced by increased compliance with performance metrics and decreased risk-adjusted mortality over the first two years of the ongoing initiative. A state-wide initiative using regulations and non-financial incentives appears to have substantially changed care," the researchers wrote.

The study's lead author, Brown University Professor of Medicine Mitchell Levy, MD, told HealthLeaders this week that there were six primary operational burdens on hospitals to comply with the state mandate:

1. Administration of data abstraction and collection
    
2. Incorporation of mandated sepsis care with existing quality improvement efforts
    
3. Costs associated with data extraction and analysis
    
4. Establishing stakeholder cooperation such as overcoming physician resistance to some elements of the sepsis protocols and care bundles
    
5. Identifying patients early for appropriate treatment
    
6. Competing priorities from other regulatory initiatives