RATIONALE In 2013, the New York State Department of Health (NYSDOH) began a mandatory state-wide initiative to improve early recognition and treatment of severe sepsis and septic shock. OBJECTIVES This study examines protocol initiation, 3-hour and 6-hour sepsis bundle completion, and risk-adjusted hospital mortality among adult patients with severe sepsis and septic shock. METHODS Cohort analysis included all patients from all 185 hospitals in New York State reported to the NYSDOH from April 1, 2014, to June 30, 2016. A total of 113,380 cases were submitted to NYSDOH, of which 91,357 hospitalizations from 183 hospitals met study inclusion criteria. NYSDOH required all hospitals to submit and follow evidence-informed protocols (including elements of 3-h and 6-h sepsis bundles: lactate measurement, early blood cultures and antibiotic administration, fluids, and vasopressors) for early identification and treatment of severe sepsis or septic shock. MEASUREMENTS AND MAIN RESULTS Compliance with elements of the sepsis bundles and risk-adjusted mortality were studied. Of 91,357 patients, 74,293 (81.3%) had the sepsis protocol initiated. Among these individuals, 3-hour bundle compliance increased from 53.4% to 64.7% during the study period (P < 0.001), whereas among those eligible for the 6-hour bundle (n = 35,307) compliance increased from 23.9% to 30.8% (P < 0.001). Risk-adjusted mortality decreased from 28.8% to 24.4% (P < 0.001) in patients among whom a sepsis protocol was initiated. Greater hospital compliance with 3-hour and 6-hour bundles was associated with shorter length of stay and lower risk and reliability-adjusted mortality. CONCLUSIONS New York's statewide initiative increased compliance with sepsis-performance measures. Risk-adjusted sepsis mortality decreased during the initiative and was associated with increased hospital-level compliance.

中文翻译：

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与脓毒症强制公开报告相关的死亡率变化。纽约州倡议的结果。

基本原理 2013 年，纽约州卫生部 (NYSDOH) 启动了一项强制性的全州范围举措，以改善严重败血症和败血性休克的早期识别和治疗。目的 本研究考察了严重脓毒症和脓毒性休克成年患者的方案启动、3 小时和 6 小时脓毒症集束治疗完成情况以及风险调整后的医院死亡率。方法 队列分析包括 2014 年 4 月 1 日至 2016 年 6 月 30 日向 NYSDOH 报告的纽约州所有 185 家医院的所有患者。总共向 NYSDOH 提交了 113,380 例病例，其中 183 家医院的 91,357 例住院病例符合研究纳入条件标准。NYSDOH 要求所有医院提交并遵循以证据为依据的方案（包括 3 小时和 6 小时脓毒症捆绑包的要素：乳酸测量、早期血培养和抗生素给药、液体和血管升压药），以便及早识别和治疗严重脓毒症或败血性休克。测量和主要结果 研究了脓毒症集束要素的依从性和风险调整死亡率。在 91,357 名患者中，74,293 名患者（81.3%）启动了脓毒症治疗方案。在这些人中，研究期间 3 小时捆绑的依从性从 53.4% 增加到 64.7% (P < 0.001)，而在符合 6 小时捆绑条件的人 (n = 35,307) 中，依从性从 23.9% 增加到 30.8%（ P < 0.001）。开始脓毒症治疗方案的患者的风险调整死亡率从 28.8% 下降至 24.4% (P < 0.001)。医院对 3 小时和 6 小时捆绑治疗的依从性较高，与较短的住院时间以及较低的风险和可靠性调整死亡率相关。结论 纽约州的全州倡议提高了脓毒症绩效指标的遵守率。在该计划期间，风险调整后的脓毒症死亡率有所下降，并且与医院层面的依从性提高有关。