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Ann Emerg Med. 2018 Jan;71(1):10-15.e1. doi: 10.1016/j.annemergmed.2017.06.032. Epub 2017 Aug 5.

Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL).

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Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT. Electronic address:
Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
Department of Emergency Medicine, University of Tennessee College of Medicine, Chattanooga, TN.
Department of Surgery, Acute and Critical Care Surgery and Department of Medicine, Emergency Medicine, Washington University, St. Louis, MO.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
American College of Emergency Physicians, Washington, DC.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.



We describe current hospital-level performance for the Centers for Medicare & Medicaid Services' Severe Sepsis/Septic Shock Early Management Bundle (SEP-1) quality measure and qualitatively assess emergency department (ED) sepsis quality improvement best practice implementation.


Using a standardized Web-based submission portal, we surveyed quality improvement data from volunteer hospital-based EDs participating in the Emergency Quality Network Sepsis Initiative. Each hospital submitted preliminary SEP-1 local chart review data, using existing Centers for Medicare & Medicaid Services definitions. We report descriptive statistics of SEP-1 data availability and performance. The primary outcome for this study was SEP-1 bundle compliance, defined as the proportion of all severe sepsis and septic shock cases receiving all required bundle elements, and secondary outcomes included conditional compliance on reported SEP-1 numerator components and ED implementation of sepsis quality improvement best practices.


A total of 50 EDs participated in the survey; 74% were nonteaching sites and 26% were affiliated with academic centers. Of all participating EDs, 80% were in regions with relatively high population density. The mean hospital SEP-1 bundle compliance was 54% (interquartile range 30% to 75%). Bundle compliance improved during fiscal year 2016 from 39% to 57%. Broad variation existed for each bundle component, with intravenous fluid resuscitation and repeated lactate bundle elements having the widest variation and largest gaps in quality. At least one consensus sepsis quality improvement best practice implementation occurred in 92% of participating sites.


Preliminary data on SEP-1 performance suggest wide hospital-level variation in performance, with modest improvement during the first year of data collection.

[Indexed for MEDLINE]

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