Organizational Factors Associated with Sepsis Bundle Compliance: A Nationwide Study

Abstract

Sepsis is one of the leading causes of mortality in the United States (U.S.), accounting for over 220 000 deaths annually. To address the issue of mortality, the Centers for Medicare and Medicaid Services (CMS) launched a core measure with an associated clinical bundle. This measure requires completion of time‐sensitive bundled interventions (eg, fluid resuscitation, antibiotics). Completion of these interventions is known to improve the odds of survival. CMS reimbursement is not currently tied to a certain compliance level; however, it is under consideration. Hospitals’ compliance with the bundle is publicly reported as the SEP‐1 measure. The objective of this study was to examine which hospital organizational factors were associated with high and low compliance with the SEP‐1 measure.This study used a cross‐sectional design with 2017 hospital‐level data from the CMS Timely and Effective Care dataset, and the American Hospital Association (AHA)’s Annual Survey. A multivariate logistic regression with outcome variable of hospital compliance (high/low) with the SEP‐1 measure (0 = less than overall average on SEP‐1 score; 1 = greater than overall average) was performed. Control variables included: number of beds (<100, 100‐250, >250), teaching status (teaching, nonteaching), technology level (high, low), intensive care unit (ICU) beds (none, 1‐4, 5‐14, 15‐29, 30 or more), ownership (government, non‐for‐profit, for‐profit), sepsis case volume (0‐100, 101‐200, 201 or more), nurse hours per patient day, and Magnet certification status (yes/no).The study included 2429 acute care, nonspecialty adult U.S. hospitals. Hospitals were excluded if they did not complete the AHA survey.The overall average SEP1 score was 48.9% on a 0‐100 scale. Of 2429 hospitals, 49% were high compliance hospitals, and 51% were low compliance. Factors associated with increased odds of compliance included: for‐profit ownership (OR = 2.48; 95% CI = 1.78‐3.44; P < .01), higher sepsis case volume (OR 1.18, 95% CI 1.08‐1.28, P < .01), smaller numbers (5‐14) of ICU beds (OR 1.76, 95% CI 1.17‐2.63, P = .01), and more nursing hours (OR 1.01, 95% CI 1.00‐1.02, P < .01). Factors associated with decreased odds of compliance included: more than 250 hospital beds (OR 0.68, 95% CI 0.47‐0.99, P = .02), and teaching status (OR 0.58, 95% CI 0.41‐0.81, P < .01).For‐profit ownership, higher sepsis case volumes, a smaller number of ICU beds, and more nursing hours per patient day were positively associated with SEP‐1 bundle compliance. A higher number of total hospital beds (>250) and having a residency program (teaching hospital) were negatively associated with compliance.Sepsis is the most expensive condition treated in U.S. hospitals, and hospitals must consider how they can improve their outcomes. Two strategies hospitals could consider are restricting the size of their ICUs to allow for closer monitoring, and increasing their nurse staffing.Florida Nurses Foundation and Sigma Theta Tau International Theta Epsilon Chapter.