In October 2015, Medicare initiated a requirement that all hospitals report their adherence to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). The SEP-1 is also referred to as the “hour-1 bundle” that encourages clinicians to act as quickly as possible to obtain blood cultures, administer broad spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and begin vasopressors if clinically indicated.

In a study published in the Annals of Internal Medicine, it evaluated the effect of SEP-1 on treatment patterns and patient outcomes using repeated cross-sectional cohorts of patients with 11 hospitals within an integrated health system. The study was performed between January 2013 and December 2017 for adults with sepsis who were hospitalized through the emergency department.

Implementation of the SEP-1 mandatory reporting program was associated with variable changes in process measures, without improvements in clinical outcomes. The Infectious Diseases Society of America and 5 other endorsing societies have officially recommended that lactate measurement be removed from the national Severe Sepsis and Septic Shock Early management Bundle. Revising the measure may optimize its future effect.