| Info As Of | Not available |
| Description | This measure focuses on adults 18 years and older with a diagnosis of severe sepsis or septic shock. Consistent with Surviving Sepsis Campaign guidelines, the measure contains several elements, including measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement. As reflected in the data elements and their definitions, these elements should be performed in the early management of severe sepsis and septic shock. |
| Numerator | The number of patients in the denominator who received ALL of the following components (if applicable) for the early management of severe sepsis and septic shock: initial lactate levels, blood cultures, antibiotics, fluid resuscitation, repeat lactate level, vasopressors, and volume status and tissue perfusion reassessment. |
| Denominator | Inpatients age 18 and over with an ICD-10-CM Principal or Other Diagnosis Code of Sepsis, Severe Sepsis, or Septic Shock. |
| Denominator Exclusions | The following patients are excluded from the denominator: Severe sepsis is not present Patients Transferred in from another acute care facility Patients receiving IV antibiotics for more than 24 hours prior to presentation of severe sepsis. Patients with a Directive for Comfort Care or Palliative Care within 3 hours of presentation of severe sepsis Patients with an Administrative Contraindication to Care within 6 hours of presentation of severe sepsis Patients with an Administrative Contraindication to Care within 6 hours of presentation of septic shock Patients with a Directive for Comfort Care or Palliative Care within 6 hours of presentation of septic shock Patients with septic shock who are discharged within 6 hours of presentation Patients with severe sepsis who are discharged within 6 hours of presentation Patients with a Length of Stay >120 days Patients included in a Clinical Trial |
| Rationale | The evidence cited for all components of this measure is directly related to decreases in organ failure, overall reductions in hospital mortality, length of stay, and costs of care. A principle of sepsis care is that clinicians must rapidly treat patients with an unknown causative organism and unknown antibiotic susceptibility. Since patients with severe sepsis have little margin for error regarding antimicrobial therapy, initial treatment should be broad spectrum to cover all likely pathogens. As soon as the causative organism is identified, based on subsequent culture and susceptibility testing, de-escalation is encouraged by selecting the most appropriate antimicrobial therapy to cover the identified pathogen, safely and cost effectively (Dellinger, 2012). Multicenter efforts to promote bundles of care for severe sepsis and septic shock were associated with improved guideline compliance and lower hospital mortality (Ferrer, 2008 and Rhodes, 2015). Even with compliance rates of less than 30%, absolute reductions in mortality of 4-6% have been noted (Levy, 2010 and Ferrer, 2008). Absolute reductions in mortality of over 20% have been seen with compliance rates of 52% (Levy, 2010). Coba et al. has shown that when all bundle elements are completed and compared to patients who do not have bundle completion, the mortality difference is 14% (2011). Thus, there is a direct association between bundle compliance and improved mortality. Without a continuous quality initiative (CQI), even these compliance rates will not improve and will decrease over time (Ferrer, 2008). Multiple studies have shown that, for patients with severe sepsis, standardized order sets, enhanced bedside monitor display, telemedicine, and comprehensive CQI feedback is feasible, modifies clinician behavior, and is associated with decreased hospital mortality (Thiel, 2009; Micek, 2006; Winterbottom, 2011; Schramm, 2011; Nguyen, 2007; Loyola, 2011). |
| Evidence | Not available |
| Steward | Centers for Medicare & Medicaid Services (CMS) |
| Contact | MMSSupport@Battelle.org |
| Measure Developer | Not specified |
| Development Stage | Fully Developed |
| Measure Type | Process |
| Meaningful Measure Area | Preventable Healthcare Harm |
| Healthcare Priority | Make Care Safer by Reducing Harm Caused in the Delivery of Care |
| eCQM Spec Available | Not Available |
| NQF Endorsement Status | Endorsed |
| NQF ID | 0500 (NQF Website ) |
| Last NQF Update | 2017-07-13 |
| Target Population Age | 18+ |
| Target Population Age (High) | Not available |
| Target Population Age (Low) | 18 |
| Reporting Level | Facility |
| Conditions | Infection |
| Subconditions | Sepsis |
| Care Settings | Hospital Inpatient , Hospital/Acute Care Facility |
Core Measure Set : Not available
| Measure Group | Group Identifier | Actions |
|---|---|---|
| SEP | 01 | |
| SEP | 1 | |
| SEP | Not available |
| Info As Of | Not Available |
| Program / Model Notes | |
| Data Sources | Not available |
| Purposes | Not available |
| Quality Domain | Patient Safety |
| Reporting Frequency | Not available |
| Impacts Payment | Not available |
| Links | Actions |
|---|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|---|---|---|---|---|
| Implemented | 2016-10-01 | Not available |
http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-18545.pdf |
|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|---|---|---|---|---|
| Reference | 1900-01-01 | Not available |
|
||
| Finalized | 2014-08-22 | Not available |
http://www.gpo.gov/fdsys/pkg/FR-2015-08-17/pdf/2015-19049.pdf |
|
| Info As Of | Not Available |
| Program / Model Notes | |
| Data Sources |
Other Medical Record Electronic Clinical Data: Electronic Health Record Electronic Clinical Data Paper Medical Records |
| Purposes | Not available |
| Quality Domain | Patient Safety |
| Reporting Frequency | Not available |
| Impacts Payment | Not available |
| Links | Actions |
|---|---|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|---|---|---|---|---|
| Implemented | 2016-10-01 | Not available |
|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|
| Status | Effective Date | Comments | Links | Other Data | Actions |
|---|---|---|---|---|---|
| Finalized | 2014-08-22 | Not available |
|