Differences in Emergency Department Sepsis Care: Do Race, Sex, and Language Matter?

ABSTRACT

Study Objectives: Sepsis accounts for half of hospital deaths and is a priority area of quality measurement and improvement by the Centers for Medicare and Medicaid Services (CMS). Social determinants of health have been associated with sepsis outcomes, with racial and ethnically minoritized patients experiencing higher mortality rates and worse outcomes. Standardization of emergency department (ED) sepsis-care protocols and quality measurement have improved sepsis outcomes and are closely tracked. However, it is unknown whether there are differences in ED sepsis care protocol adherence or outcomes by race, sex, or primary language spoken. The Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure is a CMS quality measure used to bundle and track multiple elements of sepsis care that are shown to improve sepsis outcomes. This measure includes obtaining blood cultures and serum lactate measurements and timely administration of intravenous fluid and antibiotics, if indicated. In this study, we hypothesized there would be a difference in 3- hour bundle compliance based on differences in race, sex, and/or language spoken. Method(s) We conducted a retrospective chart review of adult ED patients who met SEP-1 reporting guidelines for severe sepsis, septic shock, or sepsis with organ failure, from April 8, 2019 to January 21, 2022 at a large health system in Rhode Island with over 150,000 annual ED visits. We included patients who had 3-hour bundle compliance reported to CMS. Statistical analysis was completed using univariate descriptive analyses and bivariate analyses with a chi-square test of independence. We conducted logistic regression to identify factors associated with 3-hour sepsis bundle compliance and differences in sepsis treatment by race, ethnicity, sex, primary language spoken, and use of an interpreter, adjusting for emergency severity index (ESI), disposition, inpatient department, and COVID test results. Result(s) The study population included 3,182 patients of which 44.6% (1418/3182) were female, 78.4% (2495/3182) white, and 11.3 % (360/3182) were Hispanic or Latino. The majority (85.5%, 2722/3182) spoke English. Among people who spoke a language other than English, over two-thirds (66.3%, 305/460) received an interpreter. Less than a quarter 23.5% (749/3182) had severe sepsis, over a third (35.5%, 1131/3182) had septic shock, and 40.9% (1302/3182) had sepsis with organ failure. Overall compliance with the SEP-1 bundle was low at 44.9% (1430/3182). There were no significant differences in sepsis bundle compliance by patient sex, race, ethnicity, or language spoken. Logistic regression showed a lower likelihood of compliance with the sepsis bundle among patients with severe sepsis compared to sepsis patients with organ failure (aOR 0.77 [95% CI 0.65-0.90]). Conclusion(s) Our study did not identify a disparity in SEP-1 bundle compliance by sex, race, ethnicity, or language spoken. These findings support the hypothesis that using standardized ED sepsis protocols and measures are important tools to mitigate and/or prevent disparities in ED sepsis care. We also found low compliance with the SEP-1 bundle, with higher compliance noted among individuals with more severe disease, potentially diluting differences that may exist between demographic groups. Future studies are needed in populations with higher SEP-1 compliance to determine whether there are differences by sex, race, or language spoken. No, authors do not have interests to disclose Copyright © 2022