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Introduction Sepsis is a major cause of preventable deaths in hospitals. This study aims to investigate if sepsis incidence and quality of care can be assessed using inpatient administrative health data (IAHD).Methods and analysis Design: Retrospective observational validation study using routine data to assess the diagnostic accuracy of sepsis coding in IAHD regarding sepsis diagnosis based on medical record review. Procedure: A stratified sample of 10 000 patients with an age ≥15 years treated in between 2015 and 2017 in 10 German hospitals is investigated. All available information of medical records is screened by trained physicians to identify true sepsis cases (‘gold standard’) both according to current (‘sepsis-1’) definitions and new (‘sepsis-3’) definitions. Data from medical records are linked to IAHD on patient level using a pseudonym. Analyses: Proportions of cases with sepsis according to sepsis-1 and sepsis-3 definitions are calculated and compared with estimates from coding of sepsis in IAHD. Predictive accuracy (sensitivity, specificity) of different coding abstraction strategies regarding the gold standard is estimated. Predictive accuracy of mortality risk factors obtained from IAHD regarding the respective risk factors obtained from medical records is calculated. An IAHD-based risk model for hospital mortality is compared with a record-based risk model regarding model-fit and predicted risk of death. Analyses adjust for sampling weights. The obtained estimates of sensitivity and specificity for sepsis coding in IAHD are used to estimate adjusted incidence proportions of sepsis based on German national IAHD.Ethics and dissemination The study has been approved by the ethics commission of the Jena University Hospital (No. 2018-1065-Daten). The results of the study will be discussed in an expert panel to write a memorandum on improving the utility of IAHD for epidemiological surveillance and quality management of sepsis care.Trial registration number DRKS00017775; Pre-results.

Mithilfe von Experimenten lassen sich Entscheidungen und kognitive Verzerrungen in einem kontrollierten Umfeld untersuchen. Erkenntnisse aus Experimenten können Aufschluss darüber geben, wie Nudges effektiv und effizient angewendet werden können und wo von deren Nutzung abgesehen werden sollte. In einem Online durchgeführten Experiment habenwir soziales Feedback als exemplarischen Nudge eingesetzt. Wir vermuten, dass soziales Feedback zu einer höheren Leistungsfähigkeit und Arbeitsproduktivität motiviert. In dem Experiment mussten Versuchspersonen die Rolle einer Lehrerin oder eines Lehrers einnehmen und fiktive Diktate von Schülerinnen und Schülern korrigieren. Die Ergebnisse dieses Experiments weisen darauf hin, dass die Versuchspersonen Diktate schneller korrigierten, wenn sie nach Ablauf der ersten Hälfte des Experiments negatives soziales Feedback erhielten. Gleichsam wurden diejenigen langsamer, die in der ersten Hälfte des Experiments schneller waren als der Durchschnitt. Allerdings gab es auch eine Kehrseite des sozialen Nudgings: Versuchspersonen machten infolge des sozialen Feedbacks mehr Fehler. Es kam stark auf die spezifische Ausgestaltung des sozialen Nudges an, ob mit seiner Hilfe insgesamt ein positiver Effekt erzielt werden konnte. With the help of experiments, decision-making phenomena and cognitive biases can be examined more closely for their applicability as potential nudges in a controlled environment. These insights can shed light on how nudges can be applied effectively and efficiently, and where one should refrain from using them. Social feedback was used as an exemplary nudge in an online experiment. It is assumed, that social feedback can motivate subjects to be more productive. In the experiment, subjects had to slip into the role of a teacher and correct fictional dictations of students. Results of this experiment indicate that subjects generally corrected dictations faster if they had previously received negative social feedback. Likewise, those who were faster than the average, got slower after the intervention. However, there is also a downside to social nudging: subjects have made more mistakes during correction as a result of social feedback. Therefore it depends on the specific design of the social nudge, whether with its help, it is possible to achieve an overall positive effect on productivity.