2099. Use of Infectious Diseases Source-Specific Electronic Sepsis Order Sets is associated with Improved Survival in Sepsis: An Evaluation of 46 Hospitals in a Large Health Care System

Abstract

BackgroundCompliance with evidence-based treatment bundles in patients with sepsis can lead to improved survival in persons with sepsis or septic shock. A way to ensure the adoption of best practices is the early use standardized order sets based on suspected source of infection.MethodsThe patient population was built by connecting electronic health record (EHR) to administrative data. In the EHR, we identified patients who had a sepsis discharge diagnosis code based on the International Statistical Classification of Disease and Related Health Problems (ICD−10), from August 1, 2018 to February 28, 2019. We evaluated the empiric use of sepsis order sets and patient outcomes. We adjusted for age, gender, Elixhauser Comorbidity Score (ECS), intensive care unit (ICU) status, and admission type. For the analysis, we included patients age 18 and older from facilities where we were able to match greater than 70 percent of patients. Matching was done by facility on medical record number and discharge date.ResultsThere were 26,604 patients included in the analysis. The overall mortality rate was 10.67% (n = 2,839). Mortality associated with sepsis in patients that had a sepsis order set used was 8.92% (791/8,872), while for those whom a sepsis order set was not used was 11.55% (2,048/17,732). When mortality data were adjusted for age, gender, ECS, ICU status, admission type and hospital size, the use of sepsis order sets was associated with an adjusted odds ratio of 0.793 (95% CI 0.722, 0.868). In addition, in all sepsis patients who had an ICU admission, the use of the sepsis order sets was associated with an adjusted odds ratio of 0.804 (95% CI 0.725, 0.890). Similarly, in all sepsis patients who did not have an ICU admission, the use of the sepsis order sets was associated with an adjusted odds ratio of 0.688 (95% CI 0.556, 0.847).ConclusionThe use of the standardized sepsis order sets in patients with sepsis was associated with a 20.7% relative risk reduction in mortality. In conjunction with rapid recognition of sepsis, early initiation of the sepsis order sets may lead to improved mortality in patients with sepsis. Disclosures All authors: No reported disclosures.