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  • Measure Summary
  • NQMC:004035
  • Jan 2007

Sepsis: percent of patients with septic shock who received steroids within 24 hours following septic shock identification.

VHA, Inc. Transformation of the intensive care unit: sepsis data collection toolkit. Irving (TX): VHA, Inc.; 2007 Jan 1. 29 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in November 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percent of patients with septic shock who received steroids within 24 hours following septic shock identification.

Rationale

Studies show that annually there are between 500,000 to one million cases of sepsis and severe sepsis in American hospitals. The annual mortality rate for these cases is between 15 and 30 percent or as many as 200,000 deaths. Many more patients suffer from permanent organ damage. The cost to society in dollars spent and lives lost prematurely is enormous. While there are many useful clinical interventions, research shows that they are applied inconsistently, if at all.

A large, well-done, randomized clinical trial demonstrated that empiric use of steroids in patients with severe sepsis or septic shock was associated with a significant reduction in mortality. However, this benefit was limited to patients with relative adrenal insufficiency, patients that failed to increase their cortisol levels by nine in response to a corticotropin stimulation test. Among this group, there was a 10 percent absolute reduction in mortality when treated appropriately. As such, the evidence indicates: a) a corticotropin stimulation test on all patients with severe sepsis or septic shock and then b) empirically treating patients with severe sepsis or septic shock with steroids (50 mg of hydrocortisone every six hours plus 0.1 mg of Flurinef twice daily). In patients whose cortisol increases by less than nine in response to the stimulation test (called non-responders), steroids should be continued for one week and then discontinued. Longer term use of steroids may cause increased morbidity.

Evidence for Rationale

Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaud P, Bellissant E. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71. PubMed External Web Site Policy

VHA, Inc. Improving sepsis care in the intensive care unit: an evidence-based approach. Irving (TX): VHA, Inc.; 2004. 60 p.

Primary Health Components

Septic shock; steroid administration

Denominator Description

Total number of patients, 16 years of age and older, with a diagnosis of septic shock (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients who received steroids within 24 hours prior to and 24 hours following septic shock identification (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

A study confirmed that patients with severe sepsis consume significant resources. The average hospital length of stay was 20 days at an average cost of $22,100. National cost estimates for the care of severe sepsis based on this study is $16.7 billion dollars, with the care of patients older than 65 costing $8.7 billion (52.3 percent), and care of those older than 75 costs $5.1 billion dollars (30.8 percent). The costs for caring for patients with sepsis are projected to rise approximately 1.5 percent per year due to the aging U.S. population.

Evidence for Additional Information Supporting Need for the Measure

VHA, Inc. Improving sepsis care in the intensive care unit: an evidence-based approach. Irving (TX): VHA, Inc.; 2004. 60 p.

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

Internal quality improvement

Quality of care research

Measurement Setting

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 16 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
Total number of patients, 16 years of age and older, with a diagnosis of septic shock

Exclusions
Any one of the following:

  • Patients less than 16 years of age
  • Not Applicable because:
    • Patient had severe allergies to steroids
    • Had contraindications/reasons for not receiving steroids
    • Care was withdrawn or patient expired within 24 hours following septic shock identification
  • Patients were on chronic steroids (as defined in Appendix B: Chronic Steroid Equivalency Table of the original measure documentation) within 24 hours prior to septic shock identification
  • Corticotropin stimulation test results were routinely available within 6 hours of ordering the test
  • Date or Time of septic shock identification unknown
  • Cases with a time elapsed EARLIER THAN -24 hours or GREATER THAN +72 hours. Time elapsed is the difference between septic shock identification and the administration of steroid.

Note: Refer to the original measure documentation for definitions and additional details.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients who received steroids within 24 hours prior to and 24 hours following septic shock identification

Exclusions
Any one of the following:

  • Date or Time of steroid administration unknown
  • "Not Administered" was selected

Numerator Search Strategy

Institutionalization

Data Source

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Steroids received within 24 hours following septic shock identification.

Measure Collection Name

Transformation of the Intensive Care Unit (TICU) Measures

Measure Set Name

Sepsis Quality Indicators

Submitter

Vizient, Inc. - For Profit Organization

Developer

Vizient, Inc. - For Profit Organization

Funding Source(s)

VHA, Inc.

Composition of the Group that Developed the Measure

Internal VHA, Inc. clinical subject matter experts along with external clinical subject matter faculty experts from various National and local research medical centers/hospitals

Financial Disclosures/Other Potential Conflicts of Interest

None; work was not supported by any third party vendors, contractors or for-profit health care companies including suppliers, device makers, or pharmaceutical firms.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2007 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in November 2015.

Source(s)

VHA, Inc. Transformation of the intensive care unit: sepsis data collection toolkit. Irving (TX): VHA, Inc.; 2007 Jan 1. 29 p.

Measure Availability

Source not available electronically.

For more information, contact VHA, Inc. at: 220 E. Las Colinas Blvd., Irving, TX 75039; Phone: 1-800-842-5146 or 1-972-830-0626; Web site: www.vha.com External Web Site Policy.

Companion Documents

The following is available:

  • VHA, Inc. Improving Sepsis Care in the Intensive Care Unit: An Evidence-Based Approach. Irving (TX): VHA, Inc.; 2004. 60 p.

For more information, contact VHA, Inc. at: 220 E. Las Colinas Blvd., Irving, TX 75039; Phone: 1-800-842-5146 or 1-972-830-0626; Web site: www.vha.com External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on September 23, 2008. The information was verified by the measure developer on November 13, 2008.

This NQMC summary was retrofitted into the new template on May 12, 2011.

The information was reaffirmed by the measure developer on November 10, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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