SEP-1, the new national quality measure on sepsis, resulted from an undertaking to standardize care for severe sepsis and septic shock regardless of the size of the emergency department where the patient is being treated. SEP-1 does not necessarily follow the best current evidence available. Nevertheless, a thorough understanding of SEP-1 is crucial because all hospitals and emergency providers will be accountable for meeting the requirements of this measure. SEP-1 is the first national quality measure on early management of sepsis care. This article provides a review of SEP-1 and all its potential implications on sepsis care in the United States.
Key points
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The Centers for Medicare and Medicaid Services have enacted an executive branch rule (quality measure) known as SEP-1 that mandates the administration of a bundle that carefully prescribes precisely how patients with severe sepsis and septic shock must be treated in the early phases.
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CMS measures are meant to reflect best evidence and consensus practices. The provisions of SEP-1, however, are highly controversial among sepsis experts.
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CMS quality measures can fall under hospital-compare or value-based purchasing regimes. SEP-1 is currently hospital-compare, meaning that individual cases are not reimbursed differently depending on adherence. Rather a hospital’s overall adherence is compared with others and rated publically.
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The definitions for severe sepsis and septic shock used in SEP-1 are not the same as those used in the four major prospective sepsis trials on which the measure was supposedly based.
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Some of the provisions of SEP-1 may be harmful to certain patients. The inclusion and exclusion criteria are not the same as the major prospective trials that were relied on.
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The administrative burden of SEP-1 is unprecedented. To our knowledge, SEP-1 is the largest quality measure ever introduced by CMS by virtue of the number of required actions to achieve adherence.
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There are several contraindications to administering the SEP-1 bundle. We describe those and other approaches to avoid administering the provisions of SEP-1 to those who may be harmed by it.
Related posts:
Severe Sepsis Care in the Emergency Department
End Points of Sepsis Resuscitation
The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1
Appropriate Antibiotic Therapy
Source Identification and Source Control
Sepsis Resuscitation in Resource-Limited Settings
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