New IDSA Statement Raises Concerns, Offers Recommendations to Improve National Quality Measure for Sepsis Care
Statement also Endorsed by Five Specialty Societies
Sepsis, a complication of infection that can cause low blood pressure (shock) as well as lung, kidney, and organ failure, affects an estimated 1.7 million adults each year in the U.S. and contributes to 270,000 deaths. While a national quality measure appropriately establishes sepsis as a national priority for quality improvement, the current measure raises patient care concerns and should be revised, according to a new statement authored by the Infectious Diseases Society of America and endorsed by several other specialty societies.
As outlined in a new position paper published in Clinical Infectious Diseases, IDSA recommends changes to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1), which was implemented in 2015 by the Centers for Medicare and Medicaid Services and requires hospitals to publicly report their compliance with a set, or bundle, of care measures, in order to receive additional payments.
“IDSA’s recommended changes are aimed at achieving a better balance between immediate antibiotic treatment for the sickest patients who truly stand to benefit—and reducing unnecessary antibiotic prescribing for patients who are less sick or may have another illness not related to infection,” said Henry Masur, M.D., FIDSA, chair of the IDSA Sepsis Task Force, which developed the position paper. “IDSA would like to reduce the rush to judgement that the current bundle has inadvertently encouraged.”
The current SEP-1 measure emphasizes giving broad-spectrum antibiotics to all patients with possible sepsis, including a large fraction of patients who could quickly be determined not to be septic—or to not need powerful broad-spectrum agents—if additional time were devoted to serial observations and additional diagnostic tests. The IDSA position paper provides several suggestions to modify SEP-1 so that the bundle focuses more effectively on elements that clearly promote better outcomes and minimize the unintended adverse consequences of the current bundle. IDSA’s recommendations are also endorsed by the American College of Emergency Physicians, the Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, the Society of Infectious Diseases Pharmacists, and the Society of Hospital Medicine.
“IDSA is establishing a consortium of professional societies to analyze sepsis data and recommend to CMS bundle elements that would encourage best practices for patients with life-threatening infections that are more evidence based, would reduce antibiotic overuse, and would reduce the labor required to report the bundle metrics,” Dr. Masur said.
Overuse of antibiotics leads to the development of antibiotic resistance, a major and growing threat to public health. Antibiotics also can have serious harmful effects for individual patients including organ damage, disruption of a person’s microbial flora or microbiome, and may lead to complications such as the development of C. difficile infection. These concerns underscore the need to ensure that antibiotics are used appropriately in patients most likely to benefit and stopped quickly when no longer needed.
The new recommendations also urge that the SEP-1 bundle continue to focus on drawing blood cultures before giving antibiotics as well as on administering antibiotics within one hour of septic shock being recognized in a patient. However, the criteria for when septic shock is present should be simplified so that it is less subjective and easier to determine. Hospitals also should be required to track and report how long it takes from the time antibiotics are ordered for a patient with septic shock to the time those antibiotics are actually administered to help minimize that time interval. IDSA and its partner stakeholders are engaging with CMS officials to discuss these recommendations and others outlined in the position paper.
“Sepsis is a leading cause of hospitalizations and mortality in the United States,” Dr. Masur said. “We’re very pleased to be able to constructively engage CMS about how to refine the SEP-1 bundle further, working with colleagues from across the heath care community to continue improving the care of these patients.”
IDSA is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The society, which has over 12,000 members, was founded in 1963 and is based in Arlington, Va.