Sepsis is a deadly infection that affects up to 3 million patients each year, with mortality rates ranging from 14.7% to 29.9%. Last fall, federal regulators issued a new quality improvement measure that sets specific, time-sensitive criteria hospitals should follow to treat patients with sepsis or septic shock, writes Deborah Levenson in February’s CLN.
The Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) specifies that hospitals should draw lactate, send blood samples for culture, and start broad-spectrum antibiotics from a list approved by SEP-1 within 3 hours from the time a patient presents in an emergency department. They have 6 hours to repeat a lactate test if a reading is ≥2 mmol/L.
Septic shock patients should start on a 30 cc intravenous bolus and vasopressors within 3 hours, and within 6 hours hospitals should assess a patient’s volume status and tissue perfusion. A CLN Stat article published on Sept. 17, 2015, describes this new measure in greater detail.
Many hospitals have been struggling to meet SEP-1’s exacting standards. Levenson’s article describes why meeting these standards to save lives is a worthy challenge.
As the administrators of lactate, platelets, and coagulation tests, labs play an important role in meeting the SEP-1 measures. One expert in Levenson’s article mentions the advantages of setting up point-of-care testing, especially for lactate.
What constitutes an appropriate definition of severe sepsis has been debated widely in the medical community. Under SEP-1’s definition, a patient’s condition qualifies as sepsis if there’s a suspected source of infection, two systemic inflammatory response syndrome criteria, and evidence of end-organ dysfunction.
As various experts discuss in Levenson’s article, not all hospitals use lactate ≥2 mmol/L as part of the definition for end-organ dysfunction in severe sepsis. The focus on organ failure has also been up for questioning, as sepsis is just one of many conditions that can lead to organ failure.
Pick up the February CLN and learn more about successfully implementing the SEP-1 measures, and why labs should view the management of sepsis as a “team sport.”