Impact of Sepsis Mandates on Sepsis Care: Unintended Consequences

The creation of dedicated sepsis guidelines and their broad dissemination over the past 2 decades have contributed to significant improvements in sepsis care. These successes have spurred the creation of bundled care mandates by major healthcare payers, such as the Center for Medicare and Medicaid S...

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Bibliographic Details
Published in:The Journal of infectious diseases 2020-07, Vol.222 (Suppl 2), p.S166-S173
Main Authors: Swenson, Kai E, Winslow, Dean L
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
Fluid Therapy
Humans
Lactic Acid - blood
Patient Care Bundles
Practice Guidelines as Topic
Quality of Health Care
Sepsis - diagnosis
Sepsis - therapy
Shock, Septic - diagnosis
Shock, Septic - therapy
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Summary:The creation of dedicated sepsis guidelines and their broad dissemination over the past 2 decades have contributed to significant improvements in sepsis care. These successes have spurred the creation of bundled care mandates by major healthcare payers, such as the Center for Medicare and Medicaid Services. However, despite the likely benefits of guideline-directed sepsis bundles, mandated treatments in sepsis may lead to unintended consequences as the standard of care in sepsis improves. In particular, the heterogeneous spectrum of presentation and disease severity in sepsis, as well as the complexity surrounding the benefits of specific interventions in sepsis, argues for an individualized and titrated approach to interventions: an approach generally not afforded by care mandates. In this review, we review the risks and benefits of mandated care for sepsis, with particular emphasis on the potential adverse consequences of common bundle components such as early empiric antibiotics, weight-based fluid administration, and serum lactate monitoring. Unlike guideline-directed care, mandated care in sepsis precludes providers from tailoring treatments to heterogeneous clinical scenarios and may lead to unintended harms for individual patients.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa133