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Revamping Sepsis Metrics: New Recommendations Aim to Refine Patient Care and Outcomes

A cohort of eminent medical professional societies, led by the Infectious Diseases Society of America, recently put forward recommendations for the adaptation of sepsis metrics set forth by the Centers for Medicare and Medicaid Services (CMS). The motive behind the modifications is to enhance sepsis care and subsequent patient outcomes. Sepsis has a significant impact on healthcare, with over 1.7 million US adults requiring hospital treatment each year and more than 250,000 resulting mortalities, involuntarily pushing clinicians, hospitals, policymakers, and advocates for the patients to become engaged and responsive.

The key recommendation of these multidisciplinary societies is the retirement of the CMS’ Severe Sepsis/Septic Shock Management Bundle (SEP-1), rather than its assimilation into the Hospital Value-Based Purchasing Program. SEP-1, as it currently stands, mandates that a bundle of care be administered to all suspected sepsis patients within a three-hour window following initial recognition. Components of this care package include drawing blood cultures, the dispensing of broad-spectrum antibiotics, and other interventions.

Arguments against the efficacy of the SEP-1 measure are rooted in the assertion that it neglects to account for the array of severe conditions which manifest in a way similar to sepsis. The current approach, whereby all such patients are treated under the assumption of sepsis, can result in the excessive administration of broad-spectrum antibiotics. This overcompensation can have adverse effects on patients who are not infected, those infected with viruses as opposed to bacteria, and those sufferers who could be adequately treated through narrower spectrum antibiotics.

Furthermore, recent studies indicate that the implementation of the SEP-1 measure has failed to decrease mortality rates tied to sepsis. Independent examinations of hundreds of hospitals have established a correlation between the rollout of SEP-1 and an increase in broad-spectrum antibiotic usage, laboratory testing, and fluid administration – while patient outcomes remain unaffected.

The professional societies highly commend the CMS on its efforts to establish newer sepsis measures, focusing principally on sepsis mortality rates. Refinement of this measure would enable hospitals to prioritize the factors most significant to patients and their families – improving overall outcomes. Suggested alterations to the measure include the incorporation of enhanced diagnostic strategies, optimization of sepsis patient care throughout hospitalization, and improved post-sepsis care rehabilitation services.

According to Chanu Rhee, MD, MPH, and the lead author of the recommendations, the reinforcement of measures related to sepsis prevention and the development of a sepsis mortality measure would facilitate hospitals in intensifying their focus on comprehensive sepsis care. The transition away from previous metrics in exchange for improved measures is expected to stimulate advances in diagnostic and treatment procedures, ensuring improved patient outcomes.

The multidisciplinary professional collaboratives comprise esteemed institutions such as the Society for Healthcare Epidemiology of America, the Pediatric Infectious Diseases Society, the Infectious Diseases Society of America, the Society of Infectious Diseases Pharmacists, the Society of Hospital Medicine, and the American College of Emergency Physicians.

Source: https://www.idsociety.org/news–publications-new/articles/2023/new-recommendations-to-improve-sepsis-outcomes/

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