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
Cosgrove, Sara E
Heil, Emily L
Kadri, Sameer S
Kalil, Andre C
Gilbert, David N
Septimus, Edward J
Sweeney, Daniel A
Strich, Jeffrey R
Winslow, Dean L
JournalClinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
PublisherOxford University Press
MetadataShow full item record
AbstractThe Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1's potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1's complex "time zero" definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA's core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.
Rights/TermsPublished by Oxford University Press for the Infectious Diseases Society of America 2020.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/14973
- Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multistakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis.
- Authors: Septimus EJ, Coopersmith CM, Whittle J, Hale CP, Fishman NO, Kim TJ
- Issue date: 2017 Oct 16
- The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1: The Early Management Bundle for Severe Sepsis/Septic Shock.
- Authors: Faust JS, Weingart SD
- Issue date: 2017 Feb
- Inter-rater Agreement for Abstraction of the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) Quality Measure in a Multi-Hospital Health System.
- Authors: Bauer SR, Gonet JA, Rosario RF, Griffiths LA, Kingery T, Reddy AJ
- Issue date: 2019 Feb
- Antibiotic- and Fluid-Focused Bundles Potentially Improve Sepsis Management, but High-Quality Evidence Is Lacking for the Specificity Required in the Centers for Medicare and Medicaid Service's Sepsis Bundle (SEP-1).
- Authors: Pepper DJ, Sun J, Cui X, Welsh J, Natanson C, Eichacker PQ
- Issue date: 2019 Oct
- Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1): A Systematic Review.
- Authors: Pepper DJ, Jaswal D, Sun J, Welsh J, Natanson C, Eichacker PQ
- Issue date: 2018 Apr 17