In 2013 the National Quality Foundation (NQF) endorsed the Severe Sepsis and Septic Shock: Management Bundle (SEP-1) and it was implemented by the Centers for Medicare and Medicaid Services (CMS) in October 2015, requiring emergency rooms to follow the process. The measure has seven basic elements that guide clinicians in the treatment of patients brought to the emergency room with suspected sepsis.
In our centers, we train our staff to be alert to signs and symptoms of sepsis, and we use clinical judgment on if and when to transfer a resident to the hospital. The goal of hospitalization is to evaluate and treat based on best practice however, there has been a lot of controversy surrounding the standard SEP-1 measure. In an editorial published in the Annals of Internal Medicine, physicians recommend that clinicians retain their judgment and take care of the patient not the “measure”.
Let the emergency room physicians and research experts duke it out and we will stay focused on our residents, know each of them well and recognize subtle changes that may be a flag that something is going on! Sometimes we can’t see the forest for the trees, trust your clinical judgment, you have a huge impact on the well-being of each of your residents! Stay the course, stay informed and be well!