This measure focuses on adults 18 years and older with a diagnosis of severe sepsis or septic shock. Consistent with Surviving Sepsis Campaign guidelines, it assesses measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement. As reflected in the data elements and their definitions, the first three interventions should occur within three hours of presentation of severe sepsis, while the remaining interventions are expected to occur within six hours of presentation of septic shock.
Measure Specs
General Information
Numerator
Numerator Statement: Patients who received ALL of the following:
Within three hours of presentation of severe sepsis:
• Initial lactate level measurement
• Broad spectrum or other antibiotics administered
• Blood cultures drawn prior to antibiotics
AND received within six hours of presentation of severe sepsis. ONLY if the initial lactate is elevated:
• Repeat lactate level measurement
AND within three hours of initial hypotension:
• Resuscitation with 30 mL/kg crystalloid fluids
OR within three hours of septic shock:
• Resuscitation with 30 mL/kg crystalloid fluids
AND within six hours of septic shock presentation, ONLY if hypotension persists after fluid administration:
• Vasopressors are administered
AND within six hours of septic shock presentation, if hypotension persists after fluid administration or initial lactate >= 4 mmol/L:
• Repeat volume status and tissue perfusion assessment is performed
Denominator
Inpatients age 18 and over with an ICD-10-CM Principal or Other Diagnosis Code of Sepsis, Severe Sepsis, or Septic Shock and not equal to U07.1 (COVID-19).
Exclusions
The following patients are excluded from the denominator:
• Patients with an ICD-10-CM Principal or Other Diagnosis Code of U07.1 (COVID-19)
• Directive for Comfort Care or Palliative Care within six hours of presentation of severe sepsis
• Directive for Comfort Care or Palliative Care within six hours of presentation of septic shock
• Administrative contraindication to care within six hours of presentation of severe sepsis
• Administrative contraindication to care within six hours of presentation of septic shock
• Length of Stay >120 days
• Transfer in from another acute care facility
• Patients enrolled in a clinical trial for sepsis, severe sepsis or septic shock treatment or intervention
• Patients with severe sepsis who are discharged within six hours of presentation
• Patients with septic shock who are discharged within six hours of presentation
• Patients receiving IV antibiotics for more than 24 hours prior to presentation of severe sepsis
Measure Record
Point of Contact
Emanuel Rivers
United States
Bob Dickerson
Mathematica
United States
Public Comments