Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study

Background Sepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis. Objective To compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis. Design Retrospective cohort study using multivariable analysis of clinical data. Participants A total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection. Setting Four university hospitals in California between 2014 and 2016. Main Outcomes and Measures The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen. Key Results Compared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29–0.38, p