Treating Sepsis Is Complicated: Are Governmental Regulations for Sepsis Care Too Simplistic?
Authors: John P. Kress, Jesse B. Hall
Journal: Annals of Internal Medicine (2018)

Editorials17 April 2018Treating Sepsis Is Complicated: Are Governmental Regulations for Sepsis Care Too Simplistic?John P. Kress, MD and Jesse B. Hall, MDJohn P. Kress, MDUniversity of Chicago, Chicago, Illinois (J.P.K., J.B.H.)Search for more papers by this author and Jesse B. Hall, MDUniversity of Chicago, Chicago, Illinois (J.P.K., J.B.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0290 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This article has been corrected. The original version (PDF) is appended to this article as a Supplement.When discussing complex systems … it is easy to oversimplify: I call this Occam's lobotomy.—I.J. GoodMedicine has advanced remarkably over the past several decades. Although these advances have benefited many patients with severe illnesses requiring intensive care, such as sepsis, the financial burden is staggering. In 2016, U.S. health care spending grew 4.3%, reaching $3.3 trillion (that is, $10 348 per person and 17.9% of the gross domestic product) (1); intensive care accounts for between 4% and 8% of all U.S. health care ...References1. Centers for Medicare & Medicaid Services. Historical. Updated 8 January 2018. Accessed at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html on 29 January 2018. Google Scholar2. Halpern NA, Pastores SM. Critical care medicine beds, use, occupancy, and costs in the United States: a methodological review. Crit Care Med. 2015;43:2452-9. [PMID: 26308432] doi:10.1097/CCM.0000000000001227 CrossrefMedlineGoogle Scholar3. Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf. 2005;31:243-8. [PMID: 15960014] MedlineGoogle Scholar4. Pepper DJ, Jaswal D, Sun J, Welsh J, Natanson C, Eichacker PQ. Evidence underpinning the Centers for Medicare & Medicaid Services, Severe Sepsis and Septic Shock Management Bundle (SEP-1). A systematic review. Ann Intern Med. 2018;168:558-68. doi:10.7326/M17-2947 LinkGoogle Scholar5. National Health Foundation. NQF-endorsed voluntary consensus standards for hospital care measure information form. Measure set: sepsis. Version 5.0a. 2016. Accessed at www.nhfca.org/psf/resources/Updates1/SEP-1%20Measure%20Information%20Form%20(MIF).pdf on 29 January 2018. Google Scholar6. Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, et al; FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364:2483-95. [PMID: 21615299] doi:10.1056/NEJMoa1101549 CrossrefMedlineGoogle Scholar7. Andrews B, Semler MW, Muchemwa L, Kelly P, Lakhi S, Heimburger DC, et al. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA. 2017;318:1233-1240. [PMID: 28973227] doi:10.1001/jama.2017.10913 CrossrefMedlineGoogle Scholar8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10. [PMID: 26903338] doi:10.1001/jama.2016.0287 CrossrefMedlineGoogle Scholar9. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376:2235-2244. [PMID: 28528569] doi:10.1056/NEJMoa1703058 CrossrefMedlineGoogle Scholar10. Marik P, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth. 2016;116:339-49. [PMID: 26507493] doi:10.1093/bja/aev349 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Chicago, Chicago, Illinois (J.P.K., J.B.H.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0290.Corresponding Author: John P. Kress, MD, University of Chicago, Section of Pulmonary and Critical Care Medicine, 5841 South Maryland Avenue, MC 6026, Chicago, IL 60637; e-mail, [email protected]bsd.uchicago.edu.Current Author Addresses: Drs. Kress and Hall: University of Chicago, Section of Pulmonary and Critical Care Medicine, 5841 South Maryland Avenue, MC 6026, Chicago, IL 60637.This article was published at Annals.org on 20 February 2018. A corrected version was posted on 15 March 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEvidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1) Dominique J. Pepper , Dharmvir Jaswal , Junfeng Sun , Judith Welsh , Charles Natanson , and Peter Q. Eichacker Correction: Treating Sepsis Is Complicated Metrics Cited bySepsis as Organ and Health System FailureCorrection: Treating Sepsis Is Complicated 17 April 2018Volume 168, Issue 8Page: 594-595KeywordsCritical careHealth careHemodynamicsInterleukinsMedicareObservational studiesPatientsPerformance measuresSepsisShock ePublished: 20 February 2018 Issue Published: 17 April 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...