Many septic patients receive care that fails the Centers for Medicare and Medicaid Services’ SEP-1
measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the “all-or-nothing” measure. We compared outcomes in cases that passed versus failed SEP-1
during the first 2 years after the measure was implemented.
Retrospective cohort study.
Seven U.S. hospitals.
Adult patients included in SEP-1
reporting between October 2015 and September 2017.
Measurements and Main Results:
Of 851 sepsis
cases in the cohort, 281 (33%) passed SEP-1
and 570 (67%) failed. SEP-1
failures had higher rates of septic shock
(20% vs 9%; p
< 0.001), hospital-onset sepsis
(11% vs 4%; p
= 0.001), and vague presenting symptoms (46% vs 30%; p
< 0.001). The most common reasons for failure were omission of 3- and 6-hour lactate measurements (228/570 failures, 40%). Only 86 of 570 failures (15.1%) had greater than 3-hour delays until broad-spectrum antibiotics. Cases that failed SEP-1
had higher in-hospital mortality rates (18.4% vs 11.0%; odds ratio, 1.82; 95% CI, 1.19–2.80; p
= 0.006), but this association was no longer significant after adjusting for differences in clinical characteristics and severity of illness (adjusted odds ratio, 1.36; 95% CI, 0.85–2.18; p
= 0.205). Delays of greater than 3 hours until antibiotics were significantly associated with death (adjusted odds ratio, 1.94; 95% CI, 1.04–3.62; p
= 0.038), whereas failing SEP-1
for any other reason was not (adjusted odds ratio, 1.10; 95% CI, 0.70–1.72; p
Crude mortality rates were higher in sepsis
cases that failed versus passed SEP-1
, but there was no difference after adjusting for clinical characteristics and severity of illness. Delays in antibiotic administration were associated with higher mortality but only accounted for a small fraction of SEP-1
may not clearly differentiate between high- and low-quality care, and detailed risk adjustment is necessary to properly interpret associations between SEP-1
compliance and mortality.