Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid...

Area of Science:

• Healthcare quality measurement
• Sepsis management protocols

Background:

• The Centers for Medicare and Medicaid Services (CMS) SEP-1 measure aims to standardize sepsis care.
• Accurate identification of sepsis "time zero" is critical for SEP-1 compliance.

Purpose of the Study:

• To assess inter-rater reliability for sepsis "time zero" determination.
• To evaluate the variability in perceived SEP-1 pass rates across different abstractors and institutions.

Main Methods:

• Three abstractors independently reviewed 80 sepsis cases across three hospitals.
• Agreement on sepsis "time zero" was calculated.
• Perceived SEP-1 pass rates were recorded for each abstractor.

Main Results:

• Abstractors agreed on sepsis "time zero" in only 36% of cases.
• Perceived SEP-1 pass rates varied widely, from 11% to 23%.

Conclusions:

• Significant variability exists in determining sepsis "time zero".
• Inconsistent application of SEP-1 criteria hinders its utility as a reliable quality metric.
• Revisions to SEP-1 or abstractor training may be needed to improve consistency.