Shock Index (SI) >1.3 was predictive of both hospital admission and inpatient mortality. This could act as an early warning to flag patients likely to need increased resources in the ED and a bed in the hospital.
Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.
Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues. This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.