Journal article
Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States
The Journal of rural health, Vol.35(4), pp.490-497
2019
DOI: 10.1111/jrh.12339
PMID: 30488590
Abstract
Purpose
The Centers for Medicare and Medicaid Services (CMS) and the American College of Emergency Physicians (ACEP) developed national quality measures for emergency department (ED) sepsis care. Like care for many conditions, meeting sepsis quality metrics can vary between settings. We sought to examine and compare sepsis care quality in rural vs urban hospital‐based EDs.
Methods
We analyzed data from EDs participating in the national Emergency Quality Network (E‐QUAL). We collected preliminary performance data on both the CMS measure (SEP‐1) and the ACEP measures via manual chart review. We analyzed SEP‐1 data at the hospital level based on existing CMS definitions and analyzed ACEP measure data at the patient level. We report descriptive statistics of performance variation in rural and urban EDs.
Findings
Rural EDs comprised 58 of the EDs reporting SEP‐1 results and 405 rural patient charts in the manual review. Of sites reporting SEP‐1 results, 44% were rural and demonstrated better aggregate SEP‐1 bundle adherence than urban EDs (79% vs 71%; P = .049). Both urban and rural hospitals reported high levels of compliance with the ACEP recommended initial actions of obtaining lactate and blood cultures, with urban EDs outperforming rural EDs on metrics of IV fluid administration and antibiotics (74% urban vs 60% rural; P ≤ .001; 91% urban vs 84% rural; P ≤ .001, respectively).
Conclusions
Sepsis care at both rural and urban EDs often achieves success with national metrics. However, performance on individual components of ED sepsis care demonstrates opportunities for improved processes of care at rural EDs.
Details
- Title: Subtitle
- Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States
- Creators
- Margaret B Greenwood‐Ericksen - University of New MexicoCraig Rothenberg - Yale New Haven Hospital Center for Outcomes Research and EvaluationNicholas Mohr - University of Iowa Carver College of MedicineShawn D Andrea - Tsehootsooi Medical CenterTodd Slesinger - Florida International UniversityTiffany Osborn - Washington UniversityJessica Whittle - UT Chattanooga/Erlanger Health SystemsPawan Goyal - American College of Emergency PhysiciansNalani Tarrant - American College of Emergency PhysiciansJeremiah D Schuur - Department of Emergency MedicineDonald M Yealy - University of PittsburghArjun Venkatesh - Yale New Haven Hospital Center for Outcomes Research and Evaluation
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.35(4), pp.490-497
- DOI
- 10.1111/jrh.12339
- PMID
- 30488590
- NLM abbreviation
- J Rural Health
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Number of pages
- 8
- Language
- English
- Date published
- 2019
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984024534202771
Metrics
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