November 8, 2023
PIDS is a co-signer of the statement – New Recommendations to Improve Sepsis Outcomes – reported on by Medpage Today. Our partners, which includes IDSA, SHEA, SIDP, and others, call for current Centers for Medicare & Medical Services guidelines, known as the Severe Sepsis and Septic Shock: Management Bundle (SEP-1), for treating sepsis to be replaced with performance-based measures in a Clinical Infectious Diseases position paper.
The statement reads, in part, “The SEP-1 measure requires clinicians to provide a bundle of care to all patients with possible sepsis within 3 hours of recognition. The bundle includes drawing blood cultures, administering broad-spectrum antibiotics, and other measures. However, the SEP-1 measure does not take into account that many serious conditions present in a similar fashion to sepsis.
“Pushing clinicians to treat all these patients as if they have sepsis leads to overuse of broad-spectrum antibiotics, which can be harmful to patients who are not infected, those who are infected with viruses rather than bacteria, and those who could safely be treated with narrower-spectrum antibiotics. Moreover, a series of studies published since the SEP-1 measure went into effect show that in practice SEP-1 has not lowered mortality rates.”
The position paper recommendations appeared in CID in October. The timing coincides with CMS issuing a final rule in August that will measure hospitals, starting in fiscal year 2026, on how well they comply with the sepsis guidelines as part of the Hospital Value-Based Purchasing Program. Hospitals would risk losing money if their compliance was deemed insufficient.
When reporters followed up with CMS on the sepsis position, the administrator offered no actions to be taken, but did relate that they take such statements seriously and that the recommendations will be reviewed in detail.
PIDS member Josh Wolf commented on the story and guidelines, “Even in 2023, attention to management of sepsis has the potential to save lives. The Improving Pediatric Sepsis Outcomes Collaborative recently demonstrated interventions that almost halved mortality in children with suspected sepsis, and there is still room to improve. However, mandating adherence to a specific bundle of care, using an outdated screening and reporting approach, can cause harm through inappropriate antibiotic use and misdiagnosis of sepsis mimics. We encourage Centers for Medicare & Medicaid Services to choose an alternative, evidence-based, approach to improve patient outcomes.”