Improving Sepsis Management Through the Emergency Quality Network Sepsis Initiative.

BACKGROUND: Public reporting of the Centers for Medicare & Medicaid (CMS) SEP-1 sepsis quality measure is often too late and without the data granularity to inform real-time quality improvement (QI). In response, the American College of Emergency Physicians (ACEP) Emergency Quality Network (E-QUAL) Sepsis Initiative sought to support QI efforts through benchmarking of preliminary draft SEP-1 scores for emergency department (ED) patients. This study sought to determine the anticipatory value of these preliminary SEP-1 benchmarking scores and publicly reported performance. METHODS: Cross-sectional analysis was performed on QI data collected from hospital-based ED sites participating in the E-QUAL Sepsis Collaborative in 2017 and 2018. Participating EDs submitted SEP-1 benchmarking scores semiannually, which were compared to publicly reported CMS SEP-1 data. EDs also reported implementation data on a variety of sepsis-related QI activities for comparison based on SEP-1 performance. RESULTS: Among 220 EDs participating in E-QUAL, SEP-1 benchmarking scores showed weak but statistically significant correlation with CMS SEP-1 scores (r = 0.189, p = 0.01). Mean E-QUAL SEP-1 benchmarking scores were higher than mean CMS SEP-1 scores (74.1% vs. 57.2%), with 83.2% of sites reporting a benchmarking score higher than the CMS SEP-1 score. EDs with SEP-1 scores in the bottom 20% reported completion of more sepsis-related QI activities than EDs with average or top 20% SEP-1 scores. CONCLUSION: Preliminary benchmarking results demonstrate a weak, statistically significant correlation with subsequent publicly reported CMS SEP-1 scores and suggest that ED performance in sepsis care may exceed overall hospital performance inclusive of all inpatients. Sepsis quality measurement and sepsis QI efforts may be best guided by separating ED sepsis cases from in-hospital sepsis cases as is done for other acute time-sensitive conditions.

Emergency Medicine/Internal Medicine Combined Residency Graduates Have High Career Satisfaction and Commonly Practice in Both Specialties.

OBJECTIVES: The first combined emergency medicine/internal medicine (EM/IM) residency was established in 1991. As the 30th anniversary of this unique dual-training opportunity approaches, multiple changes to the practice and educational landscape have occurred. Previous surveys examining this topic are now more than 10 years old and occurred prior to the establishment of the EM/IM/critical care medicine (EM/IM/CCM) pathway. We conducted a survey to investigate career trajectories, satisfaction, and opportunities available to EM/IM graduates. METHODS: Survey questions were developed to both allow for comparison with previously published data and examine new topics not previously investigated. A group of EM/IM and EM/IM/CCM program directors validated the survey questions. Eligible respondents were identified and contacted through their previous residency program leadership. RESULTS: Fifty-two percent (152/290) of graduates completed the survey. Thirty-seven percent of respondents practice both EM and IM, 51% practice EM only, and the remainder practice IM only. Thirty-one percent of total respondents completed a fellowship, with critical care being the most popular choice. Seventy-one percent of graduates practice in an academic center, and many hold leadership positions within education, research, and hospital administration. Eighty-seven percent of graduates were "extremely satisfied" with their choice to pursue EM/IM or EM/IM/CCM and 95% reported that they would choose this path again. CONCLUSIONS: Most respondents are satisfied with their residency choice and would choose to pursue this training again, despite the additional years of training. The proportion of graduates pursuing fellowship is higher than previously published data. Most continue to work in academics, and many are leaders within their institutions. The changing health care landscape offers multiple opportunities to dually trained graduates.