Sepsis Decision Aid

In the U.S., the treatment of sepsis and septic shock is complicated by strict regulations used to measure hospital sepsis outcomes. The Center for Medicare & Medicaid Services (CMS) Sep-1 guidelines are complex and based on chart abstraction. These factors lead to confusion and difficulty in the real-time treatment of patients. This decision aid is meant to assist in the regulatory steps for the treatment of a patient with sepsis. It is important to be aware that CMS makes changes to these criteria on a quarterly basis. This tool will be updated as often as possible to maintain correctness.

Does the patient have sepsis?

Three Hour Bundle (Items to be completed within 3 hrs)

Six Hour Bundle (Items to be completed within 6 hrs)

Important Notes

  • Patients that are excluded:
    • Age < 18 yo
    • Transferred to you from other hospital
    • Diagnosis of COVID-19 (principal or other)
    • Sepsis or septic shock due to a viral, fungal, or parasitic infection
    • Admitted to comfort care / hospice / palliative care within 6 hours of meeting sepsis criteria
    • Enrolled in a clinical trial for sepsis or septic shock during this hospitalization
    • Patients or surrogate refusing care (blood draw, cultures, antibiotics, etc.)
  • Lactic acid elevation due to a non-infectious etiology (ex. seizure) is disregarded, but must be documented by the physician or provider.
  • Requirement to use broad spectrum antibiotic was removed beginning July, 2021. Appropriate IV antibiotic selection is deferred to the treating physician or provider.

Further Reading

Updates and Controversies in the Early Management of Sepsis and Septic Shock Date Release: Apr 2021 Sepsis and septic shock guidelines, requirements, criteria, and treatments have changed substantially in the last few years. This issue reviews the latest evidence and discusses the changes and current controversies in sepsis diagnosis and management.

Current Topics in Shock and Sepsis Management: Traumatic Hemorrhagic Shock and Septic Shock Date Release: Apr 2021 This course combines audio and digital components to review critical care management of traumatic hemorrhagic shock as well as sepsis and septic shock. 


Last Updated on January 25, 2023

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