Implementation of an adult code sepsis protocol and its impact on SEP-1 core measure perfect score attainment in the ED.

INTRODUCTION: Timely management of sepsis has become an urgent concern among most hospitals. Institutions have been searching for unique ways to increase the quality of care and timely adherence to proven therapies. The objective of this study was to determine the impact of an Adult Code Sepsis Protocol on the rate of SEP-1 perfect score attainment (PSA) among patients who presented to the emergency department (ED) with severe sepsis or septic shock, as defined by the Centers for Medicare and Medicaid Services (CMS). METHODS: This was a retrospective, observational cohort study in a 35-bed tertiary care hospital ED from December 2016 to February 2018. Adults (≥18 years of age) who met the CMS-case definition of severe sepsis or septic shock presenting to the ED either prior to or after implementation of an Adult Code Sepsis Protocol were included. RESULTS: The primary outcome of SEP-1 PSA, which was abstracted in an all-or-none fashion, increased from 30.7% to 71.3% (p < 0.001). Inpatient mortality was reduced from 4% to 0% (p = 0.011) after protocol implementation. Protocol initiation also resulted in a significant reduction in both time to initiation of appropriate, empiric and effective antimicrobial therapy, based on culture results by 48 and 111 min, respectively (p < 0.001). There were no significant differences in other secondary outcomes including ICU length-of-stay, readmission, or economic outcome measures. CONCLUSIONS: The addition of an Adult Code Sepsis Protocol in the ED significantly increased the rate of SEP-1 PSA, reduced inpatient mortality, and improved the time to initiation of effective antimicrobial therapy.

Spontaneous skepticism: the interplay of motivation and expectation in responses to favorable and unfavorable medical diagnoses.

The quantity of processing view of motivated reasoning predicts that individuals are more likely to spontaneously question the validity of unfavorable than favorable feedback even when the objective likelihood of the feedback is equivalent. Participants were videotaped self-administering a bogus medical test revealing either a favorable or an unfavorable result. In Studies 1 and 2, unfavorable result participants required more time to accept the validity of the test result and were more likely to spontaneously recheck its validity than were favorable result participants. However, unfavorable results also were perceived as less expected than were favorable results, even though the information supplied about their objective likelihood was identical. Study 3 showed that participants evaluating another student's results perceived favorable and unfavorable outcomes as equally likely, suggesting that the subjective likelihood of positive and negative feedback is also subject to motivational influence.