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Regulatory Mandates for Sepsis Care — Reasons for Caution
Chanu Rhee, M.D., Shruti Gohil, M.D., M.P.H., and Michael Klompas, M.D., M.P.H.
April 16, 2014DOI: 10.1056/NEJMp1400276
Sepsis, the syndrome of dysregulated inflammation that occurs with severe infection, affects millions of people worldwide each year. Multiple studies suggest that the incidence of sepsis is dramatically increasing. According to the Centers for Disease Control and Prevention (CDC), for example, sepsis rates doubled between 2000 and 2008.1 In 2010, sepsis was the 11th leading cause of death in the United States,2 and in 2011, it was the single most expensive condition treated in hospitals.3
This apparent explosion in sepsis is spurring high-profile initiatives to promote earlier recognition and better treatment. Standardized screening protocols, bundled order sets, and algorithms for early, goal-directed therapy are becoming the norm in hospitals throughout the country. These algorithms typically require clinicians to measure lactate levels, deliver a minimum amount of fluids, draw blood for culture, and initiate treatment with broad-spectrum antibiotics, all within a narrow window of time. Some also require placement of a central venous catheter, admission to an intensive care unit (ICU), or both.
Policymakers are actively encouraging these efforts. In response to the well-publicized death of a 12-year-old boy from unrecognized sepsis, New York State now requires all hospitals to adopt sepsis protocols (“Rory's Regulations”). Later this year, New York will begin requiring hospitals to report protocol-adherence rates and outcomes. Other agencies may soon follow suit. The National Quality Forum (NQF) recently ratified a metric for adherence to sepsis protocols, and the Centers for Medicare and Medicaid Services (CMS) is considering whether to adopt the NQF metric for public reporting and payment programs.
http://www.nejm.org/doi/full/10.1056/NEJMp1400276?query=TOC#t=article