In-Hospital Sepsis
A lower rate for this indicator is desirable.
This indicator measures the rate of in-hospital sepsis per 1,000 discharges.
2 logistic regression models were built separately for children (younger than 18 years) and adults (18 years and older) to calculate the risk-adjusted results.
Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average
Unit of analysis: Single admission
Number of discharges from an acute care institution within a fiscal year
A subset of the denominator: hospital discharges with an in-hospital sepsis event identified during a hospital stay
Methodology
Name
In-Hospital Sepsis
Short/Other Names
Not applicable
Description
The risk-adjusted rate of sepsis that is identified after admission.
For further details, please see the General Methodology Notes (PDF).
Rationale
Sepsis is a clinical syndrome that occurs as a complication of infections. It is defined as a systemic inflammatory response due to infection. Sepsis is a leading cause of mortality and is linked to increased hospital resource utilization and prolonged stays in intensive care units. Appropriate preventive and therapeutic measures during a hospital stay can reduce the rate of infections and/or progression of infection to sepsis.
The indicator addresses the extent to which acute care hospitals are effective in preventing the development of sepsis. It will help hospitals improve patient safety and learn from their peers regarding best practice methods for appropriate treatment of infections and prevention of sepsis.
Interpretation
A lower rate for this indicator is desirable.
HSP Framework Dimension
ºìÁì½í¹Ï±¨ system outputs: Safe
Areas of Need
Getting Better
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Facility
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
Description
This indicator measures the rate of in-hospital sepsis per 1,000 discharges.
2 logistic regression models were built separately for children (younger than 18 years) and adults (18 years and older) to calculate the risk-adjusted results.
Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average
Unit of analysis: Single admission
Type of Measurement
Rate - Rate—per 1,000
Denominator
Description:
Number of discharges from an acute care institution within a fiscal year
Inclusions:
- Admission to an acute care institution (Facility Type Code = 1)
- Sex recorded as male or female
- Length of stay of 2 days and longer
Exclusions:
- Records with invalid age
- Records with invalid admission or discharge dates
- Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)
- Mental illness (major clinical category [MCC] of Mental Diseases and Disorders [MCC = 17]): This is to account for differences in data collection between Ontario and other provinces and territories
- Palliative care (ICD-10-CA: Z51.5) coded as most responsible diagnosis (MRDx). For Quebec data: palliative care (ICD-10-CA: Z51.5) coded as MRDx, or cancer (ICD-10-CA: C00–C97) coded as MRDx and Z51.5 coded in any secondary diagnosis field
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
- Age at admission younger than 1 year; infants are excluded because they have different mechanisms and risk factors for developing sepsis, as well as different coding standards
Numerator
Description:
A subset of the denominator: hospital discharges with an in-hospital sepsis event identified during a hospital stay
Inclusions:
Based on clinical input, the most commonly occurring and significant codes for clinical practice are included in the indicator. Sepsis events are identified as follows: Non-Quebec abstracts:
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (2)
OR - Sepsis as a post-procedural complication in the same cluster:
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (3) and infection following a procedure (ICD-10-CA: T80.2, T81.4, T82.6, T82.7, T83.5, T83.6, T84.5, T84.6, T84.7, T85.7, T88.0) as type (2) and external cause code (ICD-10-CA: Y60–Y84) as type (9) OR
- Septic shock (ICD-10-CA: R57.2) as type (3) and shock during or resulting from a procedure (ICD-10-CA: T81.1) as type (2) and external cause codes (ICD-10-CA: Y60–Y84) as type (9)
OR
- Sepsis in obstetric patients:
- Puerperal sepsis (ICD-10-CA: O85.002) as type (M), (1), (2), (W), (X) or (Y) OR
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (3) and
- Abortive outcome complicated by infection (ICD-10-CA: O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0) as type (2) OR
- Other obstetric infections (ICD-10-CA: O98.502, O98.802) as type (M), (1), (2), (W), (X) or (Y)
Quebec abstracts:
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (2)
OR - Sepsis as a post-procedural complication on the same abstract:
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (3) and infection following a procedure (ICD-10-CA: T80.2, T81.4, T82.6, T82.7, T83.5, T83.6, T84.5, T84.6, T84.7, T85.7, T88.0) as type (2) and external cause code (ICD-10-CA: Y60–Y84) as type (9) OR
- Septic shock (ICD-10-CA: R57.2) as type (3) and shock during or resulting from a procedure (ICD-10-CA: T81.1) as type (2) and external cause codes (ICD-10-CA: Y60–Y84) as type (9)
OR
- Sepsis in obstetric patients:
- Puerperal sepsis (ICD-10-CA: O85.002) as type (M), (C), (2), (W), (X) or (Y) OR
- Sepsis (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) as type (3) and
- Abortive outcome complicated by infection (ICD-10-CA: O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0) as type (2) OR
- Other obstetric infections (ICD-10-CA: O98.502, O98.802) as type (M), (C), (2), (W), (X) or (Y)
Exclusions:
Abstracts where sepsis is also identified as a pre-admit condition are excluded from the numerator:
- Abstracts with sepsis codes (ICD-10-CA: A40, A41, B37.7, R65.1, R57.2) or the associated post-procedural complication codes (ICD-10-CA: T80.2, T81.1, T81.4, T82.6, T82.7, T83.5, T83.6, T84.5, T84.6, T84.7, T85.7, T88.0) identified as pre-admit [type (M), (1) [(C) for Quebec data], (W), (X) or (Y)]
- Abstract with sepsis in obstetric patients where the puerperal sepsis code or the associated obstetric infection code is identified as pre-admit (ICD-10-CA: O85.004, O85.009, O98.501, O98.503, O98.504, O98.509, O98.801, O98.803, O98.804, O98.809 — any diagnosis type or O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0 as type (M), (1) [(C) for Quebec data], (W), (X) or (Y))
As an exception, sepsis is not considered as a pre-admit condition when the above codes identified as type (M), (W), (X) or (Y) also appear as type (2) or within a post-admit sepsis coding scenario:
- sepsis code as type (2); or sepsis code as type (3) with an associated infection code as type (2) in sepsis as post-procedural or obstetric complications.
Method of Adjustment
Logistic regression
Adjustment Applied
Covariates used in risk adjustment:
For a detailed list of covariates used in risk adjustment, please refer to the Model Specification (PDF) document.
Geographic Assignment
Place of service
Data Sources
- DAD
- HMDB
Caveats and Limitations
In-hospital sepsis events can be due to either community - or hospital-acquired infections. Therefore, the in-hospital sepsis indicator does not necessarily capture hospital-acquired infections only. In addition, despite the implementation of national coding standards, there may be variations in charting and coding practices across the country that could affect the results.
Trending Issues
Not applicable
References
Agency for ºìÁì½í¹Ï±¨care Research and Quality. Technical Specifications: Patient Safety Indicators Appendices Version 4.5. . Accessed on August 23, 2024.
Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-1310.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. In Focus: A National Look at Sepsis. Accessed on September 20, 2024.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Canadian Coding Standards for Version 2012 ICD-10-CA and CCI. Ottawa, ON: CIHI; 2012.
Drosler S. Organisation for Economic Co-operation and Development: ºìÁì½í¹Ï±¨ Care Quality Indicators Project, Patient Safety Indicators—Report 2009. Accessed on September 20, 2024.
Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010;38:367-374.
Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-1256.
Martin CM, Priestap F, Fisher H et al. A prospective, observational registry of patients with severe sepsis: the Canadian Sepsis Treatment and Response Registry. Crit Care Med 2009;37:81-88.
Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173:676-82.
How to cite:
Canadian Institute for ºìÁì½í¹Ï±¨ Information. In-Hospital Sepsis. Accessed January 4, 2025.
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For additional information, please view the In-Hospital Sepsis FAQ document.