How have we avoided SEP-1 driving us insane where I work?
(1) Fight the good fight in various committees. Especially before there were modifications to the rules (I.e. carveouts to 30mLkg, insisting 99% likely CDIFF shock get Zosyn, etc) it was VERY easy to point out that blanket application of SEP-1 harms people, and basically every doc who attended would agree, within their own perspectives (hospitalists, ED, ICU, vasc surgery, etc). The Nurses and non-clinical admins on said committees also don’t want to overtly harm people, so we could all agree to set realistic goals like setting up a system to draw serial lactates, or set up people to review cases and report on trends of actual importance, try to encourage a method to get blood cx before abx without long delays, etc.
(2) It ISN’T LINKED TO PAYMENT YET. Typically they float these metrics for a few years without linking them to $, and then once they have the infrastructure ready they link it to CMS payments. But SEP-1 got a lot of bad press, has had a lot more professional society pushback than other similar prior metrics, and also got derailed by the COVID train. It was very easy in a hospital awash with metrics and issues to say “hey guys we think this metric sucks and it does NOT affect payment, lets back burner it…” and get everyone to pretty much agree. I promise you the second it is linked to payment it will become a massive issue to everyone.
I LOVE sepsis care. I think SEP-1 is horrible. They need to break it apart. I would consider supporting something like a narrow door-to-abx metric, aimed at people presenting with true septic shock, or applied to only MAP <60 / Lactate >4 primarily septic patients.
These things are hard to abstract, and if you truly want to understand SEP-1 you have to understand each step, and all of the loopholes, and thus read a couple hundred pages of PDFs and also look through the CMS public comments to questions.
Some metrics HAVE led to improved care (I think the ACS/STEMI metrics are the best example; setting door-to-EKG times, door-to-balloon times do likely save/help patients, and encourage spending to develop a system to achieve these goals).