The following is a summary of “Do prehospital sepsis alerts decrease time to complete CMS sepsis measures?,” published in the September 2023 issue of Emergency Medicine by Troncoso, et al.
To enhance sepsis outcomes, the Centers for Medicare and Medicaid Services (CMS) instituted a time-sensitive sepsis management bundle as a fundamental quality measure, encompassing blood culture and serum lactate collection, the initiation of intravenous fluid administration, and broad-spectrum antibiotics. Despite the significance of these measures, a larger body of research needs to examine the impact of prehospital sepsis alert protocols on reducing the time required to fulfill CMS sepsis core measures.
Conducting a retrospective cohort study of patients transported via Emergency Medical Services (EMS) from December 1, 2018, to December 1, 2019, this research meticulously compares outcomes between patients who activated a prehospital sepsis alert and those who did not. The Maryland Institute for Emergency Medical Services Systems devised a sepsis protocol instructing EMS providers to alert the nearest suitable facility if a patient aged 18 and older, suspected of having an infection, presents with specific criteria: temperature >38 °C or <35.5 °C, a heart rate >100 beats per minute, a respiratory rate >25 breaths per minute or end-tidal carbon dioxide less than or equal to 32 mmHg, a systolic blood pressure <90 mmHg, or a point of care lactate reading greater than or equal to 4 mmol/L.
The findings indicated that the median time to complete all four CMS sepsis core measures was 103 minutes [IQR 61–153] for patients with a prehospital sepsis alert and 106.5 minutes [IQR 75–189] for those without (P-value 0.105). While median times were shorter for serum lactate collection (28 min. vs. 35 min., P-value 0.019), blood culture collection (28 min. vs. 38 min., P-value <0.01), and intravenous fluid administration (54 min. vs. 61 min., P-value 0.025) among patients with a sepsis alert, there was no significant difference in antibiotic administration times (94 min. vs. 103 min., P-value 0.12).
It prompted a reconsideration of the efficacy of prehospital sepsis alert protocols in expediting the completion of CMS sepsis core measures. Subsequent studies should explore the potential impact of independent antibiotic administration by EMS providers on these timeframes.