Impact of a Mental Health Diagnosis on Emergency Department Adherence to Sepsis Care Guidelines

Background: Previous work has found that clinical care for a variety of health conditions varies depending upon the mental health status of the patient. Sepsis, a condition with an algorithm-driven care plan, has not yet been investigated. This study sought to determine if disparities in care exist for people with mental illness and suspected sepsis. Methods: We conducted a retrospective medical records review of patients presenting to the emergency department with a clinical suspicion of sepsis from June 1, 2017, to January 31, 2018. Extracted data included clinical care decisions consistent with the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) national guidelines and information from the problem list and encounter notes about the presence of mental illness. Results: Seven hundred ninety-eight patient encounters were included in the study. Sixty-eight percent of these encounters had care that met the 3-hour SEP-1 bundle guidelines. The presence of a psychiatric diagnosis was not significantly related to failure of SEP-1 criteria, χ(2)(1)=1.01, P=0.315. Conclusion: This study showed no differences in clinical decision-making for patients with sepsis and a psychiatric diagnosis of mental illness. The presence of objective guidelines may have lessened the potential role of biases among clinicians toward patients with mental illness.