Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 450-bed teaching hospital implements a rapid sepsis recognition protocol in the emergency department, which includes automated EHR alerts for lactate >2 mmol/L and systemic inflammatory response criteria. Prior to implementation, the median time from triage to first antibiotic administration was 185 minutes (interquartile range 140–240 minutes). Six months after protocol rollout, analysis of 120 consecutive sepsis cases shows a median time of 98 minutes (IQR 70–130 minutes), with a p-value <0.001 on Mann-Whitney U testing. The hospital's quality improvement team notes this represents an absolute reduction of 87 minutes. Which of the following best describes the significance of this finding?
Answer choices
- AStatistically significant but clinically insignificant, as p-values <0.001 indicate the result is likely a type I error
- BNeither statistically nor clinically significant without a concurrent control group receiving standard care
- CClinically significant but not statistically significant, requiring a larger sample size to achieve p <0.05
- DBoth statistically and clinically significant; an 87-minute reduction in sepsis antibiotic administration time is associated with improved mortality outcomes in the literatureCorrect answer
- EStatistically significant due to reduced variation (lower IQR post-intervention), but the overlap in ranges suggests confounding variables affected both periods
- FClinically significant only if the reduction occurred uniformly across all patient demographics; the p-value cannot account for selection bias in the post-intervention cohort
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