Sepsis mandatory reporting

Jump to navigation Jump to search

Sepsis Microchapters


Patient Information (Adult)

Patient Information (Neonatal)




Differentiating Sepsis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis


Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray



Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies


Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sepsis mandatory reporting On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Sepsis mandatory reporting

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sepsis mandatory reporting

CDC on Sepsis mandatory reporting

Sepsis mandatory reporting in the news

Blogs on Sepsis mandatory reporting

Directions to Hospitals Treating Sepsis

Risk calculators and risk factors for Sepsis mandatory reporting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Robert G. Badgett, M.D.[2]

Synonyms and keywords: sepsis syndrome; septic shock; septicemia


Several entities have instituted mandatory reporting in their jurisdictions. These efforts are consistent with prior recommendations by the Academy of Medicine for mandatory reporting[1].

Program, owner, and year of implementation Method Impact Comments

Centers for Medicare and Medicaid Services

Public reporting at Medicare's Hospital Compare website Not studied Complex and time-consuming for hospitals to collect data[2]
Bundled Payments for Care Improvement (BPCI)[3]

Centers for Medicare and Medicaid Services


Financial incentives

No benefit after the first year of implementation[4]
Rory's Regulations

State of New York[5]

Mandatory by law Reduced mortality as compared to controlled states. Approximately half of patients in control states were accrued after announcement of plans for SEP-1 but all patients were included before implementation of SEP-1[6] Based on older SEPSIS-2[7]

Federal reporting

Mandatory reporting of sepsis quality measures, "SEP-1" by Centers for Medicare and Medicaid Services was announced 08/2014 and implemented in 10/01/2015 as a value based purchase with the possibility of financial penalties[8][9][2]. Variations in hospital mortality contributed to the rationale for SEP-1[10]. As of 2017, 87% of eligible hospitals reported compliance measures with variation in rates of compliance[11].

Concerns about the reporting is the complexity of determining compliance as the documentation for chart reviews if 120 pages and may require 2-3 hours per chart to review[2]. The SEP-1 rule has been criticized for focusing on processes of care that are hard to measure rather than more easily measured rates and outcomes[2]. As an example, abstractions of clinical charts usually disagree over determining "time zero"[12].

Related is the voluntary Bundled Payments for Care Improvement (BPCI) initiative in 2013[3]. After the first 9 months of the BPCI, 88 of 2918 eligible hospitals participated in BPCI for sepsis[4]. No difference was found in the quality or costs of sepsis care[4].

New York state reporting

In 2013, the New York State Department of Health (NYSDOH) began mandatory state-wide reporting of quality measures (Rory's Regulations)[5][13][14]. This was in part due to the death in 2012 of Rory Staunton. Implementation was based on SEPSIS-2[7]. Subsequent reduction in mortality was associated with increased compliance to process measures[14]. The benefit may be specifically linked to speed of antibiotic administration; however, study of fluids examined when fluids were finished and not when fluids were started[15].

In a controlled study, the improvement of care in New York exceeded the improvement in control states that were only under the influence of CMS pressure[6].


  1. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. 5, Error Reporting Systems. Available from:
  2. 2.0 2.1 2.2 2.3 Klompas M, Rhee C (2016). "The CMS Sepsis Mandate: Right Disease, Wrong Measure". Ann Intern Med. 165 (7): 517–518. doi:10.7326/M16-0588. PMID 27294338.
  3. 3.0 3.1 Bundled Payments for Care Improvement (BPCI) initiative: general information. Baltimore: Centers for Medicare and Medicaid Services, 2017 ( in new tab)
  4. 4.0 4.1 4.2 Joynt Maddox KE, Orav EJ, Zheng J, Epstein AM (2018). "Evaluation of Medicare's Bundled Payments Initiative for Medical Conditions". N Engl J Med. 379 (3): 260–269. doi:10.1056/NEJMsa1801569. PMID 30021090.
  5. 5.0 5.1 10 CRR-NY 405.4. Westlaw. Thomson Reuters [accessed 2019 Aug 13]. Available from:
  6. 6.0 6.1 Kahn JM, Davis BS, Yabes JG, Chang CH, Chong DH, Hershey TB; et al. (2019). "Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis". JAMA. 322 (3): 240–250. doi:10.1001/jama.2019.9021. PMC 6635905 Check |pmc= value (help). PMID 31310298.
  7. 7.0 7.1 Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D; et al. (2003). "2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference". Intensive Care Med. 29 (4): 530–8. doi:10.1007/s00134-003-1662-x. PMID 12664219.
  8. Centers for Medicare and Medicaid Services (CMS), HHS (2014). "Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule". Fed Regist. 79 (163): 49853–50536. PMID 25167590.
  9. Cooke CR, Iwashyna TJ (2014). "Sepsis mandates: improving inpatient care while advancing quality improvement". JAMA. 312 (14): 1397–8. doi:10.1001/jama.2014.11350. PMC 4813658. PMID 25291572.
  10. Hatfield KM, Dantes RB, Baggs J, Sapiano MRP, Fiore AE, Jernigan JA; et al. (2018). "Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock". Crit Care Med. 46 (11): 1753–1760. doi:10.1097/CCM.0000000000003324. PMID 30024430.
  11. Barbash IJ, Davis B, Kahn JM (2019). "National Performance on the Medicare SEP-1 Sepsis Quality Measure". Crit Care Med. 47 (8): 1026–1032. doi:10.1097/CCM.0000000000003613. PMC 6588513 Check |pmc= value (help). PMID 30585827.
  12. Rhee C, Brown SR, Jones TM, O'Brien C, Pande A, Hamad Y; et al. (2018). "Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure". Infect Control Hosp Epidemiol. 39 (8): 994–996. doi:10.1017/ice.2018.134. PMID 29932042.
  13. Rory’s Regulations. Available at
  14. 14.0 14.1 Levy MM, Gesten FC, Phillips GS, Terry KM, Seymour CW, Prescott HC; et al. (2018). "Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative". Am J Respir Crit Care Med. 198 (11): 1406–1412. doi:10.1164/rccm.201712-2545OC. PMC 6290949. PMID 30189749.
  15. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS; et al. (2017). "Time to Treatment and Mortality during Mandated Emergency Care for Sepsis". N Engl J Med. 376 (23): 2235–2244. doi:10.1056/NEJMoa1703058. PMC 5538258. PMID 28528569.

Template:WikiDoc Sources