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. 2015 Nov;12(11):1676–1684. doi: 10.1513/AnnalsATS.201503-163BC

Table 3.

Phrasing (or paraphrasing, if official phrasing was unavailable) used by each organization to describe how the metric should be measured to assess bundle compliance

Metric Surviving Sepsis 2012 KPNC 2014 Intermountain Healthcare 2014 NQF 2014 Loma Linda 2009 MHA 2014
Lactate measured “Serum lactate measured within 3 h of presentation” Number of patients with lactate collected within 1 h Serum lactate measured Requires a response of “yes” to the question: “Was a lactate level obtained within 3 h of time of presentation?” Percentage of patients who had lactate measured “Percentage of patients who had a lactate level measured”
             
Blood cultures collected “Blood cultures collected before broad-spectrum antibiotics administered”   Blood cultures obtained prior to antibiotic administration Requires a response of “yes” to the question: “Were blood cultures obtained prior to antibiotic administration and within 3 h of time of presentation?” Percentage of patients with cultures obtained prior to antibiotics “Percentage of patients who obtained blood cultures prior to administration of antibiotics”
             
Antibiotics given “Broad spectrum antibiotics administered within 3 h of admission” (Combined Y/N completion measure with antibiotics, fluid administration and repeat lactate) Broad-spectrum antibiotics administered within 3 h from ED arrival Requires a response of “yes” to the question: “Were broad spectrum antibiotics administered within 3 h of the time of presentation?” Percentage of patients with antibiotics within 4 h of meeting bundle criteria “Percentage of patients who received broad spectrum antibiotics within one hour of diagnosis of severe sepsis or septic shock” *Bundle  = within 3 h
             
Antibiotics appropriate           “Percentage of patients who received appropriate antibiotic based on culture and sensitivity”
             
Fluid given “30 ml/kg crystalloid fluid bolus delivered” *Bundle = within 3 h, metric is Y/N within 24 h (Combined Y/N completion measure with antibiotics, fluid administration and repeat lactate) Fluid bolus of 30 ml/kg PBW of crystalloid IV administered for hypotension (MAP) <65 or SBP <90 and/or lactate ≥4 mmol/L Requires a response of “yes” or “not applicable” to the question: “Were 30 ml/kg of crystalloid administered for hypotension or lactate ≥4 mmol/L within 6 h of the time of presentation?”   “Percentage of patients who received 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L”
             
Vasopressors given for hypotension “Apply vasopressors for hypotension to maintain MAP ≥ 65”   Vasopressors applied to maintain MAP ≥60 mm Hg if hypotension does not respond to initial 30 ml/kg PBW fluid Requires a response of “yes” or “not applicable” to the question: “Were vasopressors applied within 6 h of the time of presentation for hypotension that did not respond to initial fluid resuscitation to maintain a mean arterial pressure ≥ 65 mm Hg?”    
             
MAP target achieved   Patients at MAP target at 6 h after time zero     Percentage of patients with MAP ≥ 65 mm Hg or SBP ≥90 mm Hg within 6 h “Percentage of patients for whom a goal of MAP ≥65 mm Hg was achieved within six hours”
             
CVP measured CVP measured within 6 h of presentation          
CVP target achieved CVP ≥8 achieved within 6 h of presentation CVP within target at 6 h after time zero If, after fluids, MAP < 60 and/or most recent lactate ≥ 4, was either A or B achieved:

  • A) CVP ≥ 8 AND ScvO2 ≥ 70%

  • B) If using NICOM protocol, until patient is either no longer fluid responsive or becomes stable off vasopressors AND until cardiac index is ≥2.5 L/min/m2

   Percentage of patients with CVP ≥8 mm Hg within 6 h “Percentage of patients for whom a goal of CVP ≥8 mm Hg was achieved within six hours”
ScvO2 measured ScvO2 measured within 6 h of presentation          
             
ScvO2 target achieved ScvO2 70% (or SvO2 65%) achieved within 6 h of presentation ScvO2 within target at 6 h If, after fluids, MAP < 60 and/or most recent lactate ≥ 4, was either A or B achieved:

  • A) CVP ≥ 8 AND ScvO2 ≥ 70%

  • B) If using NICOM protocol, until patient is either no longer fluid responsive or becomes stable off vasopressors AND until cardiac index ≥ 2.5 L/min/m2

   Percentage of patients with ScvO2 ≥ 70% within 6 h Percentage of patients for whom a goal of ScvO2≥70% was achieved within six hours
Repeat lactate Remeasure lactate Combined Y/N completion measure with antibiotics, fluid administration, and repeat lactate If initial lactate ≥ 2 mmol/L, repeat measurement within 6 h of ED arrival Requires a response of “yes” or “not applicable” to the question: “Was serum lactate re-measured if initially elevated within 6 h of presentation”    
Lactate clearance   Intermediate and high lactate clearance within 12 h of index lactate       Percentage of patients who had a normalization of lactate within six hours

Definition of abbreviations: CVP = central venous pressure; ED = emergency department; IV = intravenous; KPNC = Kaiser Permanente Northern California; MAP = mean arterial pressure; MHA = Michigan Health & Hospital Association; NICOM = noninvasive cardiac output monitoring; NQF = National Quality Forum; PBW=predicted body weight; SBP = systolic blood pressure; ScvO2 = central venous oxygen saturation; SvO2 = venous oxygen saturation; Y/N = binary yes/no scoring.

If statement is not described as a percentage, it is a yes (all parts of the statement are true) or no question.

*

Indicates discrepancies between timing goals within bundle and timing measured by metric.