How do we reduce sepsis nationwide?

Sepsis contributes to 1.7 million hospitalizations annually and 1 in 3 of all hospital deaths in the US according to the most recent estimates from the Centers for Disease Control and Prevention (CDC). 

To attempt to reduce this burden, the Centers for Medicare & Medicaid Services (CMS) instituted the Severe Sepsis/Septic Shock Management Bundle, or SEP-1 measure, in 2015, which requires hospitals to provide certain interventions within the first three hours of the recognition of sepsis. 

The SEP-1 measure officially transitioned from a reporting measure to a pay-for-performance measure on January 1 of this year, meaning that hospitals don’t just have to track how well they’re doing on sepsis care, but could face financial penalties if they don’t do well enough. Meanwhile, the federal government is actively seeking other ways to drive improvements in sepsis care.

Hallie Prescott, M.D. of the Michigan Medicine Division of Pulmonary and Critical Care Medicine, has studied sepsis care for years, as well as caring for patients with the condition at University of Michigan Health’s hospitals. 

Working at the state and national level, she has worked to expand sepsis care improvement efforts, serving as a subject matter expert for CDC’s Hospital Sepsis Program Core Elements guidance, published in August 2023. 

What led to your involvement with the CDC Hospital Sepsis Program?

The CDC reached out to me as a content expert in sepsis management and policy. In addition to researching sepsis and co-chairing the Surviving Sepsis Campaign Guidelines, I lead a Michigan statewide sepsis initiative funded by Blue Cross Blue Shield of Michigan with 69 participating hospitals from around the state of Michigan. It is one of the biggest sepsis quality improvement programs in the country. 

As leader of this sepsis initiative, I was able to get broad input from our hospitals to ensure the CDC’s Hospital Sepsis Program Core Elements were responsive to the perspectives and needs of all US hospital settings. 

What are the goals of the CDC program?

At a high level, the goal of the new CDC program is to provide hospitals with a ‘manager’s guide’ on how to develop and run and effective hospital sepsis program. The SEP-1 measure has incentivized just a handful of care practices in the first three hours following sepsis recognition but does not tell hospitals how to improve delivery of these care practice, nor address ongoing management. 

The Core Elements guides hospitals to establishing and running an effective hospital sepsis program to monitor and drive forward care in a hospital. Uptake of the core elements will be tracked nationally through the National Healthcare Safety Network annual survey, which is put out by CDC to all 5,000-plus U.S. hospitals. 

It is possible that some components of the Core Elements may be mandated or tied to incentives as some point in the future, as happened with the Antibiotic Stewardship Core Elements.

What are the core elements?

The core elements consist of hospital leadership commitment, accountability, multi-professional expertise, action, tracking, reporting and education. Concrete examples are provided within each domain, which are further stratified into “priority” and “additional” examples so that hospitals can prioritize their next steps. 

The guide is designed so that every hospital in the U.S. can look at it and find something to work on, regardless of where they’re starting, from a critical access hospital starting from ground zero up to a large academic medical center with a mature sepsis program looking to improve.

Why now?

Sepsis continues to be a leading cause of hospitalization, mortality, and healthcare costs, and the federal government has been looking for ways to improve care and outcomes. 

SEP-1 was elevated to pay-for-performance in January in hopes to drive further improvements in early management. There is a 30-day mortality measure for sepsis currently in development by CDC and CMS, which in the coming years will be publicly reported on Hospital Compare for all hospitals.

The hope is that these process and outcome measures will nudge hospitals to double down on improving sepsis care.  This Core Elements guidance basically explains how to double down in an effective way and make change.