Has the Medicare Sepsis Performance Measure (SEP-1) Catalyzed Better Outcomes for Patients With Sepsis?
Authors: Michael Klompas, Chanu Rhee
Journal: Annals of Internal Medicine (2021)

EditorialsJuly 2021Has the Medicare Sepsis Performance Measure (SEP-1) Catalyzed Better Outcomes for Patients With Sepsis?Michael Klompas, MD, MPH and Chanu Rhee, MD, MPHMichael Klompas, MD, MPHHarvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital Boston, Massachusetts and Chanu Rhee, MD, MPHHarvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-1571 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In October 2015, the Centers for Medicare & Medicaid Services implemented the Medicare Sepsis Performance Measure (SEP-1), requiring U.S. hospitals to report adherence to a sepsis management bundle that includes obtaining blood cultures, checking serum lactate levels, administering broad-spectrum antibiotics, and if patients are hypotensive or have elevated lactate levels, infusing 30 mL/kg of body weight of intravenous crystalloids within 3 hours of sepsis time zero, as defined by the measure. The bundle further requires rechecking serum lactate if the initial level was elevated, starting vasopressors for persistent hypotension, and documenting a repeated volume status examination within 6 hours.The ...References1. Rhee C, Chiotos K, Cosgrove SE, et al. Infectious Diseases Society of America position paper: recommended revisions to the national Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) sepsis quality measure. Clin Infect Dis. 2021;72:541-552.[PMID: 32374861] doi:10.1093/cid/ciaa059 CrossrefMedlineGoogle Scholar2. Barbash IJ, Davis BS, Yabes JG, et al. Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1). Ann Intern Med. 2021;174:927-935. doi:10.7326/M20-5043 Google Scholar3. Hernández G, Ospina-Tascón GA, Damiani LP, et al; The ANDROMEDA SHOCK Investigators and the Latin America Intensive Care Network (LIVEN). Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321:654-664.[PMID: 30772908] doi:10.1001/jama.2019.0071 CrossrefMedlineGoogle Scholar4. Weinberger J, Rhee C, Klompas M. A critical analysis of the literature on time-to-antibiotics in suspected sepsis. J Infect Dis. 2020;222:S110-S118. [PMID: 32691835] doi:10.1093/infdis/jiaa146 CrossrefMedlineGoogle Scholar5. Bulle EB, Peake SL, Finnis M, et al; ARISE Investigators. Time to antimicrobial therapy in septic shock patients treated with an early goal-directed resuscitation protocol: a post-hoc analysis of the ARISE trial. Emerg Med Australas. 2020. doi:10.1111/1742-6723.13634 Google Scholar6. Filbin MR, Lynch J, Gillingham TD, et al. Presenting symptoms independently predict mortality in septic shock: importance of a previously unmeasured confounder. Crit Care Med. 2018;46:1592-1599. [PMID: 29965833] doi:10.1097/CCM.0000000000003260 CrossrefMedlineGoogle Scholar7. Alam N, Oskam E, Stassen PM, et al; PHANTASi Trial Investigators and the ORCA (Onderzoeks Consortium Acute Geneeskunde) Research Consortium the Netherlands. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med. 2018;6:40-50. [PMID: 29196046] doi:10.1016/S2213-2600(17)30469-1 CrossrefMedlineGoogle Scholar8. Rhee C, Jones TM, Hamad Y, et al; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Netw Open. 2019;2:e187571. [PMID: 30768188] doi:10.1001/jamanetworkopen.2018.7571 CrossrefMedlineGoogle Scholar9. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care. 2015;19:319. [PMID: 26346055] doi:10.1186/s13054-015-1035-1 CrossrefMedlineGoogle Scholar10. Shappell C, Klompas M, Ochoa A, et al. Likelihood of bactrerial infection in patients treated with broad-spectrum intravenous antibiotics in the emergency department. Crit Care Med. 2021. [Forthcoming]. Google Scholar Author, Article, and Disclosure InformationAffiliations: Harvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital Boston, MassachusettsDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1571.Corresponding Author: Michael Klompas, MD, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215; e-mail, [email protected]harvard.edu.Current Author Addresses: Drs. Klompas and Rhee: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215.This article was published at Annals.org on 20 April 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals On Call - Does the Sepsis Bundle Improve Outcomes? Robert M. Centor , Michael Klompas , and Chanu Rhee Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1) Ian J. Barbash , Billie S. Davis , Jonathan G. Yabes , Chris W. Seymour , Derek C. Angus , and Jeremy M. Kahn Metrics Cited byAssessing Fluid Intolerance with Doppler Ultrasonography: A Physiological FrameworkAssociation Between Implementation of the Severe Sepsis and Septic Shock Early Management Bundle Performance Measure and Outcomes in Patients With Suspected Sepsis in US Hospitals July 2021Volume 174, Issue 7Page: 1010-1011KeywordsAntibioticsCritical careDeath ratesEmergency departmentHealth careLactatesMedicareMortalityPerformance measuresSepsis ePublished: 20 April 2021 Issue Published: July 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...