Sepsis Definitions: The Search for Gold and What CMS Got Wrong

Abstract

On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.

Sepsis 2019: What Surgeons Need to Know

“…To further complicate matters, the Centers for Medicare and Medicaid Services (CMS) has an alternate definition for sepsis and septic shock that continues to use the prior definitions, plus the use of specific end-organ dysfunction criteria and lactate criteria [18]. Whereas the cost and reimbursement implications of these discrepancies are outside of the scope of this review, the use of multiple definitions of sepsis will likely have far-reaching clinical, research, administrative, and economic impact.…”

Does the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Improve Survival in Septic Adults?

“…During the past several decades, the definition of sepsis, severe sepsis, and septic shock has been heavily debated, and having one definition for sepsis can lead to misclassification of disease processes. 3,5 Even if sepsis is correctly identified, the unknown safety index of CMS's mandated interventions poses another problem with SEP-1. CMS's time-sensitive protocol can result in clinicians' administering unwarranted treatments, with potential negative ramifications.…”

“…6 Because the standard fluid bolus of 30 mL/kg in this bundle is not adjusted on comorbidities, this volume can cause harm to patients with congestive heart failure, chronic kidney disease, and chronic liver disease. 3,5 Clinicians should be able to titrate the resuscitation by patient and allow for deviation in the setting of well-documented clinical judgment. A one-size-fits-all approach for diagnosis and treatment places constraints on clinicians and forces them to do what may not be considered best practice instead of instituting their clinical judgment.…”

Sepsis Screening Tool Increased the Usage of Sepsis Order Set

“…Since 1992, the definitions of sepsis, severe sepsis, and septic shock have been heavily debated (Kalantari, Mallemat, & Weingart, 2017). Multiple consensus statements have been released and attempted to incorporate concepts reflecting an updated understanding of the pathophysiology of sepsis (Kalantari et al, 2017). However, none have been perfect or accepted as good standard (Kalantari et al, 2017).…”

“…Multiple consensus statements have been released and attempted to incorporate concepts reflecting an updated understanding of the pathophysiology of sepsis (Kalantari et al, 2017). However, none have been perfect or accepted as good standard (Kalantari et al, 2017). So far, there have been five definitions of severe sepsis that were published during the past 25 years.…”