Comparison of quality of sepsis care among patients with vs. without acute mental health crises

IntroductionSepsis is a life-threatening ailment caused by an exaggerated immune response to infection that poses a major health problem, with increasing prevalence, high costs, and poor outcomes. Improved outcomes are seen in patients when providers follow the Surviving Sepsis Campaign recommended clinical practice guidelines for identifying and treating sepsis using a 3-hour and 6-hour bundle after sepsis is suspected. Previous research has shown patients with mental health issues receive worse quality of diabetes and cardiac care and have poorer outcomes compared with those without mental health issues. Similarly, patients with mental health issues may receive worse sepsis care due to inability to explain symptoms, agitation, etc. This study explores sepsis quality of care among patients with vs. without an acute mental health crisis, and whether patients with certain mental health issues were more likely to receive sepsis bundle care than others. MethodsUsing data extracted from 2018-2019 at the Long Island Jewish Medical Center Emergency Department (ED), patients who met sepsis inclusion criteria were grouped into either having, or not having, a severe mental illness crisis on the basis of whether physical or chemical restraints were used in the ED. Patients with a history of a severe mental illness, but who were not in a severe mental health crisis, were grouped with the patients without mental health illness, as, in the absence of an acute psychiatric problem, their mental health issue unlikely affected sepsis care. We describe demographic characteristics of both groups and performed a univariate analysis using Students T-test to compare the percent of those with vs. without acute mental health crisis who received full 3- and 6-hour sepsis bundle care. Patients with an acute mental health crisis were grouped according to "cognitive" (eg, dementia) vs. "non-cognitive" (eg, schizophrenia) disorders. ResultsComparing those with vs. without acute mental health crisis, there was no difference in the percent of patients who received 3-hour sepsis bundle care (80.7% vs 74.9%, p = 0.1456). However, among patients who received the 3-hour bundle, a significantly-greater percent of those with an acute mental health crisis received the 6-hour sepsis bundle (51.0% vs. 30.7%, p <0.0001). There was no difference between different groups of patients with mental health issues (eg, "cognitive" vs. "non-cognitive") with respect to receiving 3- or 6-hour sepsis bundle care. DiscussionSurprisingly, although there was no significant difference in likelihood to receive a 3-hour sepsis bundle among patients with vs. without an acute mental health crisis, those with an acute mental health crisis were more-likely to receive 6-hour care. We suspect this difference might be due to increased attention paid to patients with an acute mental health crisis, including more-frequent room visits by hospital staff or more concerns among family members. No particular set of mental health conditions was associated with receiving or not receiving appropriate care. Future research could address possible confounding factors, go into more detail about the specific component of the sepsis protocol that patients failed to receive, and specify what aspects of a mental health crisis affected treatment plans. Future studies are needed to assess possible associations between severe mental illness crisis, bundle care, and mortality in relation to ED, Intensive Care Unit (ICU), or hospital length-of-stay (LOS).