Becker's Clinical Quality & Infection Control

39 QUALITY IMPROVEMENT & MEASUREMENT Epic's sepsis model has conflicting results: 6 things to know By Hannah Mitchell A study from researchers at Cleveland-based MetroHealth found that Epic's sepsis warning system, which is used at hundreds of U.S. hos- pitals and health systems, is associated with adminis- tering antibiotics faster, according to an Aug. 20 study published in Critical Care Medicine. To conduct the study, researchers analyzed the emer- gency department of an unnamed academic, safety-net health system from August to December 2019. Patients were randomized to standard sepsis care or standard care augmented by a flag in Epic's EHR and an EHR- based emergency department pharmacist notification. Six things to know: 1. e study measured the time it took to administer antibiotics from the patients' ER arrival. ere were 598 patients examined in the study over a span of five months. 2. e study found that patients in the augmented group were given antibiotics in a shorter time. e average time to administer antibiotics with patients in the early sepsis warning group was 2.3 hours, compared to 3 hours for patients in the standard care group. 3. e study also found that the rates of antibiotic uti- lization and fluid resuscitation did not differ. ere wasn't an increase of undesirable or harmful clinical observations observed in the patient group that used Epic's sepsis model, according to the report. 4. e study was launched aer mixed results from separate studies on the effectiveness of the model, according to the report. 5. A June 21 study published in JAMA Internal Medi- cine found that Epic's model performed worse than claimed on the prediction tool's fact sheet. To evalu- ate the model, researchers from Michigan Medicine in Ann Arbor looked at nearly 40,000 hospitaliza- tions across the health system from 2018-19. 6. Findings showed the prediction tool correctly sorted patients on their risk of sepsis 63 per- cent of the time, lower than the 76 percent to 83 percent curve indicated on the model's fact sheet, researchers said. n CDC launches payer feedback toolkit to reduce unnecessary antibiotics By Nick Moran T he CDC in September released a toolkit for payers that allows them to provide feedback to providers on outpatient antibiotic prescriptions and improve use. Developed alongside Pew, the toolkit aims to cut down on antibi- otic overprescription, as a third of outpatient antibiotics end up being unnecessary, according to the Sept. 15 announcement. "All antibiotic use contributes to resistance, and most antibiotics in the U.S. are given in outpatient settings — many of them inap- propriately," said David Hyun, MD, director of The Pew Charitable Trusts Antibiotic Resistance Project. "Insurance companies can give providers the information they need to improve antibiotic steward- ship, and the new toolkit from CDC gives them a roadmap." n Hospitals slam Lown Institute's social responsibility ranking By Alia Paavola T he American Hospital Association took aim in September at the Lown Institute's social responsibility ranking, which ranks 3,010 hospitals across the U.S. on 54 metrics. The ranking from the nonpartisan healthcare think tank was released Sept. 21. Some of the metrics used in the ranking were inclusivity, pay equity, avoiding overuse and clinical outcomes, as well as cost efficiency, a new metric that evaluates how well hospitals achieve low mortality rates at a low cost. The AHA claimed that the index from the Lown Institute drew "sweeping and arbitrary conclusions" and used "old and incomplete data." In particular, the AHA said that the inclusivity metric only looks at Medicare data, which is not representative of the community hospi- tals care for. "Hospitals treat the patients who come through their doors regard- less of their ability to pay, and those who do enter the hospital may or may not match with the demographics of the Medicare popula- tion," the AHA said. "Yet Lown penalizes hospitals whose patient mix does not match the local Medicare population." The AHA also said the Lown Institute used mortality as the only clini- cal outcome for measuring cost efficiency. "These and other shortcomings may explain why researchers them- selves acknowledge the index won't help patients actually choose between hospitals," the AHA concluded. n

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