Dear Colleagues, Many members of the listserv have asked if CMS will follow suit with the Hour 1 Bundle. As it turns out, that's simply not possible, even if it is a good idea. I'll explain a couple reasons here, but please take note that the Hour 1 Bundle in no way conflicts with SEP-1, and it can only help you with your SEP-1 performance if you strive for the Hour 1 Bundle targets - you'll be well on your way to passing SEP-1.
The shortest answer as to why CMS can't simply adopt the Hour 1 Bundle is that government rulemaking requires typically that new measures are adopted after they have been approved at NQF. This is not always so, but the government has chosen this path with sepsis measures. Passing NQF requires that a measure has been extensively tested in the real world and that there is data to support advancing the measure to NQF. As the Hour 1 Bundle is new, it will be necessary to allow time to pass for hospitals to accrue data applicable to its implementation before something could be ready for presentation to NQF (perhaps months to years) and then, assuming passage at NQF, converting to a measure suitable for the IQR would take up to a year with rulemaking. None of this should stop hospitals from working on the Hour 1 Bundle. That data supporting the importance of timely interventions is highly suggestive that getting therapies started in the first hour is a laudable goal. If you have found that you have run out of interventions to promote change at your facility, optimizing your processes to come into compliance with the Hour 1 Bundle gives you a great new place to start. Thanks, Sean From: Sepsisgroups [mailto:[email protected]] On Behalf Of Lori Harmon Sent: Monday, May 21, 2018 6:17 AM To: [email protected] Subject: [**External**] [Sepsis Groups] Hour-1 Bundle Announced WARNING: This email originated outside of the Sutter Health email system! DO NOT CLICK links if the sender is unknown and never provide your User ID or Password. Dear Colleagues, A new Surviving Sepsis Campaign (SSC) Hour 1 Bundle<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org%2FBundles%2FPages&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=CwZTu56yEi7QU3aNr2ng9G%2BHAKsT1Hsx250VfCZyv6U%3D&reserved=0> was released after being updated to reflect the latest evidence from the International Guidelines for Management of Sepsis and Septic Shock 2016. <https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org%2FGuidelines%2FPages%2Fdefault.aspx&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=iFSk8LxBX2CPnKnH%2F4Qkbt%2Fu5uYueotqfTRXITul23k%3D&reserved=0>The most important change in the revision of the SSC bundles is that the 3-hour and 6-hour bundles have been combined into a single "Hour-1 Bundle" with the explicit intention of beginning resuscitation and management immediately. This new sepsis "Hour-1 Bundle" should be introduced to staff in the emergency department (ED), wards, and intensive care unit as the next iteration of ever-improving tools in the care of patients with sepsis and septic shock as we all work to lessen the global burden of sepsis. Reflecting the latest evidence, the Hour-1 Bundle highlights five steps that healthcare professionals should begin as soon as sepsis is recognized: * Measure the blood lactate level. A high lactate level indicates that the tissues are not getting enough oxygen from the blood. * Perform blood cultures to identify the cause of the infection. Blood samples should be taken before antibiotics are administered, if possible. * Administer broad-spectrum antibiotics that are active against the causative organism. * Start intravenous fluids. Fluid resuscitation is an essential step to stabilize the patient's condition. * Administer vasopressors to raise blood pressure. This is a critical resuscitation step in patients with septic shock. "There is no reason to delay treatment for patients with sepsis and septic shock," comments lead author Mitchell Levy, MD, MCCM. "Recognizing the urgent need to treatment, clinicians must (and many already do) begin treatment immediately, rather than waiting for 3 or 6 hours in these critically ill patients." The authors point out that the new revision is based on the 2016 SSC guidelines update, which provides further discussion and evidence related to each step and to comprehensive management of sepsis. They also note some important gaps in current knowledge, including the need for further studies in important subgroups such as patients with burns and compromised immune function. Thanks are extended to the members of the Surviving Sepsis Campaign Steering and Executive Committees<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org%2FAbout-SSC%2FPages%2FLeadership.aspx&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=7UuIlu%2FuvR85zSiobFDVOxNTNVouUxHBaS11pEvyDg0%3D&reserved=0> who collaborated on and approved the hour-1 bundle. Time zero remains unchanged. Read the Statement from Surviving Sepsis Campaign Leadership on Time Zero in the Emergency Department<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org%2FSiteCollectionDocuments%2FSurviving-Sepsis-Statement-Time-Zero-May-2018.pdf&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=EtDkqz73i4jpBmxBwpfCb9RprUpAntjkjBOzgFhMZ94%3D&reserved=0>. Find the new SSC Hour-1 Bundle and related resources at survivingsepsis.org/Bundle<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org%2FBundles%2FPages%2Fdefault.aspx&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=E7vmFrgZ39N2yINxwxm1hI9yDyFH9bpyLiUsfQYmpiM%3D&reserved=0>. SSC Executive Committee SSC Steering Committee Massimo Antonelli, MD Richard Beale, FRCA, FFICM Heatherlee Bailey, MD, FCCM Daniel De Backer, MD, PhD Jozef Kesecioglu, MD, PhD Laura Evans, MD, FCCM Mitchell Levy, MD, MCCM, FCCP Ricard Ferrer Roca, MD, PhD Andrew Rhodes, FRCP, FRCA, FFICM Ruth A. Kleinpell, RN-CS, PhD, FCCM Jerry J. Zimmerman, MD, PhD, FCCM Mitchell M. Levy, MD, MCCM, FCCP Tex Kissoon, MD, FRCP(C), FAAP, MCCM, FACPE Andrew Rhodes, FRCP, FRCA, FFICM Yasser Sakr, MD, PhD Christa A. Schorr, RN, MSN, FCCM Pierre Tissieres, MD, DSc Sean R. Townsend, MD, FCCM Lori A. Harmon, RRT, MBA | Director of Quality | Society of Critical Care Medicine Staff Partner Surviving Sepsis Campaign 500 Midway Drive, Mount Prospect, IL 60056-5811 USA t: +1 847.493.6403 | m: +1 847.693.0359 | www.survivingsepsis.org<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.survivingsepsis.org&data=02%7C01%7Ctownsesr%40sutterhealth.org%7C763fc86bb04e4dc1402508d5bf1d585d%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636625055160655013&sdata=%2FmJUpsA9UlRs45TakfnXMnCnmMgUJQTyns6uyFme0Zw%3D&reserved=0>
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