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CDC gives a nudge to hospitals on sepsis care
The Centers for Disease Control and Prevention formally called on hospitals to develop robust sepsis care programs to systematically identify and treat sepsis, track outcomes, and improve care delivery. The guidance comes as a series of recommendations dubbed the Hospital Sepsis Program Core Elements, along with an “assessment tool” that functions as a sort of checklist for compliance.
"Every hospital, regardless of size, location, and resources can strengthen the quality of care delivered to these patients and ensure their survival," CDC Director Mandy Cohen, MD, MPH, announced at the launch of the program.
Fully implemented, CDC’s toolkit would promote sepsis into the major leagues of “code strokes” and “code STEMIs” — highly prioritized system-wide operational programs enjoying executive sponsorship and significant financial and human resources.
Most large health systems have already implemented many of the recommendations, which advise hospitals to create a sepsis program spanning all inpatient care areas, and including elements such as:
A sepsis coordinator empowered by a senior executive leader
Sepsis screening tools on admission and throughout hospitalization
“Code sepsis” protocols for suspected sepsis patients
Electronic order sets for sepsis, including crystalloid infusions, antimicrobials, and vasopressors
Data collection: tracking and reporting of sepsis cases and outcomes, integrated with quality improvement programs
Continuing education and training of staff
And much, much more.
Some of the suggestions get into the weeds in a good way — like advising changes to pharmacy operations to stock antimicrobials throughout the hospital, and making antimicrobial delivery default to “now” in electronic order sets.
Others are inscrutable and creepy, like “Our hospital completes near real-time chart reviews for the purpose of clinician feedback and education.” What is that, a sepsis Stasi?
The biggest challenge in optimizing sepsis care has always been identifying the patients who need it. Unlike strokes and STEMIs, sepsis has no gold standard for diagnosis. Epic’s much-hyped sepsis screening tool was found to have only a 12% positive predictive value, while alerting on 1 of 5 of all hospitalized patients. (Epic claims to have improved it since then.)
Deployed at scale, a tool with such poor performance may save lives, but will also bring downsides of wasted effort, alarm fatigue, and professional frustration, not to mention overtreatment of not-septic patients with actual tons of excess antibiotics, while producing messy metrics that could disregard (or penalize) good clinical judgment.
And unfortunately, the CDC’s new recommendations won’t displace the widely and rightly maligned Medicare sepsis treatment regulations (SEP-1).
It’s good to see sepsis finally getting the attention it merits. Countless lives will surely be saved by increased prompt recognition and optimized treatment of this underappreciated and potentially lethal condition. Although CDC has no regulatory authority, its new program will serve as an important reference benchmark for what’s considered “good” sepsis care at U.S. hospitals.