News: SEP-1 adapts to volume concerns
Due to concerns with the crystalloid fluid administration data element within CMS’ core bundle measures for sepsis (SEP-1), CMS has modified the Specifications Manual for National Hospital Inpatient Quality Measures for the first and second quarters of 2022.
Previously, the crystalloid fluid administration data element mandated that 30mL/kg of crystalloid fluids be given within a specified timeframe. Being that the average 75-kg patient demands more than two liters of fluid, according to Erica Remer, MD, CCDS, “there is no dispensation for receiving fluids as colloids although pre-arrival fluids can be counted.” Many providers shared concerns that this large volume could be detrimental in certain patients, such as those with heart failure or renal failure.
An article published in the Academic Emergency Medicine Journal had the objective of determining what portion of patients triggering sepsis urgent treatment protocols upon presentation were ultimately diagnosed definitively with sepsis. Some of the patients in the study were deemed to be at potential risk for harm from fluid resuscitation. While 60%-75% of emergency department patients meeting Sepsis-3 criteria did not receive a sepsis diagnosis at discharge, 19%-36% had at “least one plausible risk factor for harm from large-volume fluid resuscitation.”
The modification made by CMS to the Specifications Manual for National Hospital Inpatient Quality Measures 2022 first and second quarters have added the clause to the crystalloid fluid administration requirement. The added clause states, “…or lesser volume with a reason for the lesser volume specifically documented by the physician/APN/PA.” This means that starting in January 2022, if the physician feels the previously required 30 mL/kg would be excessive, they only need to document the volume they are going to give the patient and the reason why they are not giving the recommended 30 mL/kg amount.
Editor’s note: Additional ACDIS coverage on sepsis updates can be found here.