SCCM Diagnostic Excellence Program Seeks to Transform Sepsis Care With Support of CMSS Grant

While the U.S. healthcare system has become more adept at recognizing and treating medical emergencies such as stroke and myocardial infarction, sepsis—a medical emergency that affects more people than those two conditions combined—remains significantly underdiagnosed and undertreated. With the support of the Gordon and Betty Moore Foundation through a grant program administered by the Council of Medical Specialty Societies (CMSS), the Society of Critical Care Medicine (SCCM) hopes to change that.

Sepsis is the body’s overwhelming and life-threatening response to infection, which can cause tissue damage, organ failure, and death. It affects 1.7 million people every year in the United States, more than twice as many as myocardial infarction (805,000 people) or stroke (795,000 people).^1,2,3 Sepsis kills 350,000 people annually.¹ As the leading cause of hospitalization in the United States—and the leading cause of death in U.S. hospitals—sepsis is not only a significant health issue, it is also extremely costly. The average cost per hospital stay for sepsis is double that of other conditions. Sepsis hospitalization and skilled nursing care costs more than $60 billion every year.^4,5

SCCM was one of 11 specialty organizations to receive a CMSS grant of $100,000 to improve diagnostic excellence. SCCM’s project, Using Education and Technology for Rapid Cycle Sepsis Diagnosis: Building an Equitable and Quality-Based Diagnostic Excellence Project, focuses on:

• Improving early sepsis detection and reducing delays and errors in diagnosis
• Addressing clinician implicit bias that may impact delays and errors in diagnosis, ensuring a safe and equitable healthcare environment
• Describing the impact of diagnostic delays and errors, sepsis, and septic shock on the organization’s bottom line and reputation in the community
• Disseminating just-in-time strategies and toolkits that impact patient outcomes and reduce delays and errors in diagnosis, particularly when ruling out sepsis and septic shock

“We aim to ensure all healthcare professionals understand that sepsis is a medical emergency and know what they need to do in response,” said Greg S. Martin, MD, MSc, FCCM, the principal investigator and former president of SCCM. “The CMSS grant helps SCCM create and disseminate research-based resources to reevaluate how we approach sepsis nationwide.”

 

Four Topics of Sepsis Education

SCCM’s Diagnostic Excellence Program focuses on providing education and technology for accurate and rapid-cycle sepsis diagnosis via webcasts, podcasts, and toolkits on four topics:

1. Mitigating Diagnostic Delays and Errors
2. Implementing the Hour-1 Bundle
3. Mitigating Implicit Bias in Diagnosing Patients With Sepsis
4. Engaging Healthcare Leaders in Sepsis Prevention and Progression

The educational content was created by an implementation scientist, using evidence-based research and supplemented with toolkits for each of the four topics that provide important background for understanding the significance of each topic and implementation strategies.

The first three webcasts have already been held and are available for free on the SCCM website. The fourth webcast, Engaging Healthcare Leaders in Sepsis Prevention and Progression, will be held July 26, 2023. The webcast offers one hour of accredited continuing education (ACE) credit and the accompanying podcast offers 0.25 hours of ACE credit.

 

Implementing the Hour-1 Bundle

At the core of the Diagnostic Excellence Program is wide implementation of the Hour-1 Bundle, which is based on the Surviving Sepsis Campaign’s 2021 Adult Guidelines⁶ and encourages clinicians to at least start each of the following steps within the first hour of suspicion of sepsis:

1. Measure lactate level (and remeasuring it if the initial level is elevated more than 2 mmol/L).
2. Obtain blood cultures before administering antibiotics.
3. Administer broad-spectrum antibiotics.
4. Begin rapid administration of 30-mL/kg crystalloid for hypotension or lactate level of 4 mmol/L or greater.
5. Apply vasopressors if the patient is hypotensive during or after fluid resuscitation to maintain a mean arterial pressure of 65 mm Hg or greater.

Hoping to improve the U.S. healthcare system’s diagnosis and treatment of patients with sepsis, in 2015 the Centers for Medicare and Medicaid Services (CMS) issued core measures to address the care of patients with sepsis, all of which are included in the Hour-1 Bundle. While the CMS set a three-hour window for implementing these elements, a 2019 study showed that they are accomplished less than 50% of the time.⁷

Changing the goal from completing the steps within three hours to starting the steps within one hour can help improve implementation by underscoring that sepsis is an emergency and the clock is ticking. Mortality increases by 4% to 9% every hour. Up to 80% of patients with septic shock can survive if they are rapidly diagnosed and treated.^8-10

Because as many as 87% of patients develop sepsis outside the hospital,¹¹ most go to the emergency department (ED) for care, which is why it is especially important to educate ED professionals and help them understand they should always be thinking about sepsis.

EDs are busy places with many competing priorities. As SCCM’s Diagnostic Excellence Program emphasizes, hospitals need to rethink how they approach sepsis care. Hospitals that fare best in managing sepsis have best practices in place, including sepsis response teams. The fourth webcast, Educating Healthcare Leaders in Sepsis Prevention and Progression, along with the accompanying podcast and toolkit, focuses on teaching healthcare professionals how to talk to their leaders about allocating resources for sepsis prevention by creating a multiprofessional sepsis team. When a sepsis alert is sounded, multiprofessional clinicians come together immediately, including respiratory therapist, phlebotomist, and pharmacist.

SCCM has prioritized the significant and undertreated diagnosis of sepsis. But this is only the beginning. SCCM is trying to obtain funding to create Diagnostic Excellence Program resources for other diagnoses as well.

For more information, to sign up for the July 26 webcast, and to access other diagnostic excellence materials, visit SCCM’s Diagnostic Excellence Program.

References

1. Centers for Disease Control and Prevention. What is sepsis? Page last reviewed August 9, 2022. Accessed July 7, 2023. https://www.cdc.gov/sepsis/what-is-sepsis.html
2. Centers for Disease Control and Prevention. Heart disease facts. Last reviewed May 15, 2023. Accessed July 7, 2023. https://www.cdc.gov/heartdisease/facts.htm
3. Centers for Disease Control and Prevention. Stroke facts. Last reviewed May 4, 2023. Accessed July 7, 2023. https://www.cdc.gov/stroke/facts.htm
4. Buchman TG, Simpson SQ, Sciarretta KL, et al. Sepsis among Medicare beneficiaries: 3. The methods, models, and forecasts of sepsis, 2012-2018. Crit Care Med. 2020 Mar;48(3):302-318.
5. Pfuntner A, Wier LM, Steiner C. Costs for hospital stays in the United States, 2011. Agency for Healthcare Research and Quality. Statistical brief #168. December 2013. Accessed July 7, 2023. https://hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.pdf
6. Society of Critical Care Medicine. Surviving Sepsis Campaign Guidelines 2021. November 2021. Accessed July 7, 2023. https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Surviving-Sepsis-Guidelines-2021
7. Barbash IJ, Davis B, Kahn JM. National performance on the Medicare SEP-1 Sepsis Quality Measure. Crit Care Med. 2019 Aug;47(8):1026-1032.
8. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-1596.
9. Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017 Jun 8;376(23):2235-2244.
10. Liu VX, Fielding-Singh V, Greene JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863.
11. Rhee C, Dantes R, Epstein L, et al; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017 Oct 3;318(13):1241-1249.