Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States

Margaret B. Greenwood-Ericksen, Craig Rothenberg, Nicholas Mohr, Shawn D. Andrea, Todd Slesinger, Tiffany Osborn, Jessica Whittle, Pawan Goyal, Nalani Tarrant, Jeremiah D. Schuur, Donald M. Yealy, Arjun Venkatesh

Research output: Contribution to journalArticle

Abstract

Purpose: The Centers for Medicare and Medicaid Services (CMS) and the American College of Emergency Physicians (ACEP) developed national quality measures for emergency department (ED) sepsis care. Like care for many conditions, meeting sepsis quality metrics can vary between settings. We sought to examine and compare sepsis care quality in rural vs urban hospital-based EDs. Methods: We analyzed data from EDs participating in the national Emergency Quality Network (E-QUAL). We collected preliminary performance data on both the CMS measure (SEP-1) and the ACEP measures via manual chart review. We analyzed SEP-1 data at the hospital level based on existing CMS definitions and analyzed ACEP measure data at the patient level. We report descriptive statistics of performance variation in rural and urban EDs. Findings: Rural EDs comprised 58 of the EDs reporting SEP-1 results and 405 rural patient charts in the manual review. Of sites reporting SEP-1 results, 44% were rural and demonstrated better aggregate SEP-1 bundle adherence than urban EDs (79% vs 71%; P =.049). Both urban and rural hospitals reported high levels of compliance with the ACEP recommended initial actions of obtaining lactate and blood cultures, with urban EDs outperforming rural EDs on metrics of IV fluid administration and antibiotics (74% urban vs 60% rural; P ≤.001; 91% urban vs 84% rural; P ≤.001, respectively). Conclusions: Sepsis care at both rural and urban EDs often achieves success with national metrics. However, performance on individual components of ED sepsis care demonstrates opportunities for improved processes of care at rural EDs.

Original languageEnglish (US)
Pages (from-to)490-497
Number of pages8
JournalJournal of Rural Health
Volume35
Issue number4
DOIs
StatePublished - Sep 1 2019

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Hospital Emergency Service
Sepsis
Centers for Medicare and Medicaid Services (U.S.)
Emergencies
Urban Hospitals
Physicians
Rural Hospitals
Quality of Health Care
Lactic Acid
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Greenwood-Ericksen, M. B., Rothenberg, C., Mohr, N., Andrea, S. D., Slesinger, T., Osborn, T., ... Venkatesh, A. (2019). Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States. Journal of Rural Health, 35(4), 490-497. https://doi.org/10.1111/jrh.12339

Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States. / Greenwood-Ericksen, Margaret B.; Rothenberg, Craig; Mohr, Nicholas; Andrea, Shawn D.; Slesinger, Todd; Osborn, Tiffany; Whittle, Jessica; Goyal, Pawan; Tarrant, Nalani; Schuur, Jeremiah D.; Yealy, Donald M.; Venkatesh, Arjun.

In: Journal of Rural Health, Vol. 35, No. 4, 01.09.2019, p. 490-497.

Research output: Contribution to journalArticle

Greenwood-Ericksen, MB, Rothenberg, C, Mohr, N, Andrea, SD, Slesinger, T, Osborn, T, Whittle, J, Goyal, P, Tarrant, N, Schuur, JD, Yealy, DM & Venkatesh, A 2019, 'Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States', Journal of Rural Health, vol. 35, no. 4, pp. 490-497. https://doi.org/10.1111/jrh.12339
Greenwood-Ericksen MB, Rothenberg C, Mohr N, Andrea SD, Slesinger T, Osborn T et al. Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States. Journal of Rural Health. 2019 Sep 1;35(4):490-497. https://doi.org/10.1111/jrh.12339
Greenwood-Ericksen, Margaret B. ; Rothenberg, Craig ; Mohr, Nicholas ; Andrea, Shawn D. ; Slesinger, Todd ; Osborn, Tiffany ; Whittle, Jessica ; Goyal, Pawan ; Tarrant, Nalani ; Schuur, Jeremiah D. ; Yealy, Donald M. ; Venkatesh, Arjun. / Urban and Rural Emergency Department Performance on National Quality Metrics for Sepsis Care in the United States. In: Journal of Rural Health. 2019 ; Vol. 35, No. 4. pp. 490-497.
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