996
Agreement improved to only a moderate rating when requiring just 1 of 2 clinician abstractors to agree with a hospital’s official abstractor. Sepsis onset after hospital admission was associated with lower agreement rates compared to sepsis present on admission. The SEP-1 measure relies on determining sepsis time zero to
calculate 3- and 6-hour bundle compliance rates, but several potential sources of error as well as subjectivity may have affected the results. Abstractors need to assess many different parts of the chart (eg, vital signs, laboratory tests, clinical notes, and medi- cation administration records) to determine time zero and overall SEP-1 compliance. Abstractors must exercise judgment to decide whether clinicians suspect infection, whether organ dysfunction is present, and whether organ dysfunction is new or chronic. Reviewers may also need to review dozens of progress notes, including multiple versions of the same note that have been copied and pasted, to find the first documentation of suspected infection, particularly when sepsis occurs after hospital admission. More broadly, sepsis is an elusive entity to define and identify.
There is no gold standard for sepsis, and even expert clinicians using common definitions often disagree on whether sepsis is present or absent.9,10 Our study has several limitations. Clinicians may be less adept at
abstracting data for quality measures than trained hospital abstrac- tors. We focused on agreement for sepsis time zero and overall SEP-1 pass rates, but variability in abstracting individual bundle components could also contribute to disagreements in perceived pass rates. Our study was conducted in academic hospitals and may not be generalizable to community hospitals, where sepsis cases may differ in their level of complexity. Finally, the CMS specification for SEP-1 continues to change over time, and we were unable to eval- uate the impact of recent changes on interrater reliability. In conclusion, there is significant variability between different
abstractors in determining severe sepsis time zero and SEP-1 com- pliance rates. These findings underscore the importance of ensuring adequate standardization of quality measures, especially complex ones like SEP-1, that require substantial judgment for implementation.
Chanu Rhee et al
Acknowledgments. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention or the Agency for Healthcare Research and Quality.
Financial support. This study was funded by the Prevention Epicenters Program of the Centers for Disease Control and Prevention (grant no. U54CK000484). C.R. received support from the Agency for Healthcare Research and Quality (grant no. K08HS025008).
Potential conflicts of interest. None of the authors have any conflicts to disclose.
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