A Roadmap for Successful State Sepsis Regulations-Lessons From New York

Kristin Hittle Gigli; Kimberly J Rak; Tina Batra Hershey; Grant R Martsolf; Jeremy M Kahn

doi:10.1097/CCE.0000000000000521

A Roadmap for Successful State Sepsis Regulations-Lessons From New York

Crit Care Explor. 2021 Sep 3;3(9):e0521. doi: 10.1097/CCE.0000000000000521. eCollection 2021 Sep.

Authors

Kristin Hittle Gigli^{1

2}, Kimberly J Rak¹, Tina Batra Hershey³, Grant R Martsolf^{4

5}, Jeremy M Kahn^{1

3}

Affiliations

¹ CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
² College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX.
³ Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
⁴ Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA.
⁵ RAND Corporation, Pittsburgh, PA.

Abstract

New York state implemented the first state-level sepsis regulations in 2013. These regulations were associated with improved mortality, leading other states to consider similar steps. Our objective was to provide insight into New York state's sepsis policy making process, creating a roadmap for policymakers in other states considering similar regulations.

Design: Qualitative study using semistructured interviews.

Setting: We recruited key stakeholders who had knowledge of the New York state sepsis regulations.

Subjects: Thirteen key stakeholders from three groups included four New York state policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York state sepsis regulations, as well as two members of patient advocacy groups engaged in sepsis advocacy.

Interventions: None.

Measurements and main results: We used iterative, inductive thematic analysis to identify themes related to participant perceptions of the New York state sepsis policy, factors that influenced the policy's perceived successes, and opportunities for improvement. We identified several factors that facilitated success. Among these were that policymakers engaged a diverse array of stakeholders in development, allowing them to address potential barriers to implementation and create early buy-in. Policymakers also paid specific attention to the balance between the desire for comprehensive reporting and the burden of data collection, narrowly focusing on "essential" sepsis-related data elements to reduce the burden on hospitals. In addition, the regulations touched on all three major domains of sepsis quality-structure, process, and outcomes-going beyond a data collection to give hospitals tools to improve sepsis care.

Conclusions: We identified factors that distinguish the New York sepsis regulations from less successful sepsis polices at the federal level. Ultimately, lessons from New York state provide valuable guidance to policymakers and hospital officials seeking to develop and implement policies that will improve sepsis quality.

Keywords: hospitals; policy making; quality improvement; regulations; sepsis; state policy.

Abstract

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