Protocolized Sepsis Care Lowers Sepsis Mortality in NY State

State-mandated protocolized sepsis care is associated with a greater decrease in sepsis mortality compared with that seen in states not implementing sepsis regulations, according to a study published in the issue of the Journal of the American Medical Association.

Jeremy M. Kahn, M.D., from the University of Pittsburgh, and colleagues conducted a retrospective cohort study of adult patients hospitalized with sepsis in New York state and four control states. Hospitalization for sepsis was compared before versus after implementation of the 2013 New York state sepsis regulations, mandating that hospitals implement evidence-based protocols for sepsis management. Data for 1,012,410 sepsis admissions to 509 hospitals were included in the final analysis.

The researchers found that the unadjusted 30-day in-hospital mortality was 26.3 percent in New York state and 22.0 percent in control states before the regulations and was 22.0 and 19.1 percent, respectively, after the regulations. Mortality after implementation of the regulations decreased significantly in New York state relative to the control states after adjustment for patient and hospital characteristics and preregulation temporal trends and season. No significant differences were noted in intensive care unit admission rates in association with the regulations, but there were significant relative decreases in hospital length of stay and the Clostridium difficile infection rate and a significant relative increase in central venous catheter use.

"Because baseline mortality rates differed between New York and comparison states, it is uncertain whether these findings are generalizable to other states," the authors write.

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