Written by Mary Marschner
Spoon Feed
It is unclear if the SEP-1 bundle, defined by CMS, improves outcomes or mortality of patients in this review.
Sepsis and value based purchasing… is it actually effective?
SEP-1 (Severe Sepsis and Septic Shock Early Management Bundle) is a sepsis bundle adopted by CMS at the beginning of 2024 to improve outcomes of sepsis and septic shock. It includes time to antibiotics, time and volume of fluid resuscitation, repeating lactic acid, and time of starting pressors. It is included in the Hospital Value-Based Purchasing (VBP) Program, is reported by hospitals, and tied to revenue by CMS.
The systematic review of 17 observational studies evaluated SEP-1 compliance/implementation with sepsis mortality. There was no moderate- or high-level evidence that compliance with or implementation of SEP-1 was associated with decreased sepsis mortality. Specifically, 5 studies showed a statistically significant benefit, whereas 7 did not. The conclusion was that CMS should reconsider the addition of SEP-1 to the Hospital VBP Program. The study has two main flaws. First, all studies were observational and prone to bias. Second, referenced study data were largely pre-2017, without accounting for differences between EMR system, proprietary sepsis identification or treatment bundles, and guideline changes to the sepsis definition with the Sepsis-3 guidelines in 2016.
How does this change my practice?
This study does not change my current practice of quickly and aggressively treating sepsis patients. However, now that we have standardized requirements from CMS, I am hoping to see more studies that go beyond assessing the effectiveness of SEP-1 guidelines and instead look into the effectiveness of order set implementation and warning tools, in addition to the incidence of false positives. Cardiogenic shock and obstructive shock, among others, often mimic sepsis, but antibiotics and fluids are harmful in such cases. We need to engage on what metrics are tied to revenue, but we also need to see how these metrics improve patient outcomes.
Source
The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review. Ann Intern Med. 2025 Feb 18. doi: 10.7326/ANNALS-24-02426. Epub ahead of print. PMID: 39961104
