Table 2. Summary of compliance data and other results from eight studies examining experience with the CMS sepsis bundle performance measure (SEP-1).

Study	Time period	Database		Overall SEP-1 compliance*	Other results
		Source	Hospital number
Ramsdell [2017] (38)	4/2015–2/2016	Individual chart review	1 (110 cases)	51.80%	Compliance with individual components:
					• Lactate measured: 88.2%
					• Blood cultures obtained: 88.2%
					• Antibiotics initiated: 90.0%
					• 30 mL/kg bolus
					• Repeat lactate: 80.9%
					• Vasopressor started: 71.1%
					• Volume status/tissue perfusion assessment: 34.8%
Greenwood-Ericksen [2019] (64)	10/2016–12/2016	E-QUAL**#	205 (EDs)	80% (IQR 62–95%)	Rural vs. urban hospital SEP-1 compliance:
					• Median 80% (IQR: 67–100%) vs. 80% (51–90%)
					• Mean 79% vs. 71% (P=0.049)
					• Initial lactate: 89 vs. 92% (P=0.28)
					• Initial blood cultures: 83 vs. 87% (P=0.21)
					• Antibiotics; 60 vs. 74% (P≤0.0001)
					• Fluid administration: 84 vs. 91% (P≤0.0001)
Rhee [2018] (62)	10/2015–9/2017	Individual chart review	7 (851 cases)	33%	Noncompliance within individual patients associated (P≤0.04) with:
					• Presence septic shock
					• Hospital onset sepsis
					• Vague infectious symptoms
					• Non-pulmonary infections
					40% noncompliant cases due to absence of initial or follow-up lactate level
Venkatesh [2018] (61)	10/2015–9/2016	E-QUAL**	50 (EDs)	54% (IQR 30–75%)	92% of EDs implemented QI projects to improve SEP-1 compliance
					Compliance improved from 39% to 57% during reporting year
					SEP-1 components with lowest compliance: IVF, repeat lactate, vasopressors
Barbash [2019] (66)	10/2016–9/2017	HCP**	2,851	48.9% (SD ±19.4%)	In multi-variate analysis, higher SEP-1 compliance associated with:
					• Larger reported SEP-1 case volumes (P<0.0001)
					• For profit hospitals (P<0.0001)
					• Non-teaching hospitals (P=0.04)
					• Smaller hospital size (P≤0.003)
					SEP-1 performance associated with performance on other time directed CMS measures including head CT interpretation for stroke patients, aspirin for chest pain, and ECG for chest pain patients (P<0.0001 for each)
Barbash [2019] (65)	1/2017–9/2017	HCP**	2,827	Safety-net hospitals## 46.9% (n=703)^; non-safety-net hospitals 49.2% (n=2,124)^	In adjusted analysis, decreased SEP-1 compliance in safety-net hospitals associated with:
					• Hospitals not affiliated with health system (P<0.01 for interaction)
					• Smaller hospitals (P=0.03 for interaction)
Liao [2019] (63)	4/2017–3/2018	HCP**	48	52.7% (SD ±14.8%)	In multi-variate analysis, SEP-1 compliance greater in:
					• For profit hospitals (P<0.0001)
					• Smaller hospitals with less beds (P=0.003)
Whitfield [2019] (67)	12/2016–2/2018	Individual chart review	1 (450 cases)	Pre-implementation: 30.7%; post-implementation: 71.3%	Implementation of code sepsis protocol, aiming to expedite recognition, diagnosis and treatment of patients with sepsis or septic shock
					Multidisciplinary team included emergency room physician, physician extender, triage nurse, charge nurse, clinical pharmacist, phlebotomist, and house supervisor

*, SEP-1 compliance, percentage of patients a hospital reported that received all SEP-1 components; **, E-QUAL, HCP, IQRP provided hospital level data; ^#, ACEP provided patient level data; ^##, safety-net hospitals were the top quartile of hospitals based on the proportion of Medicare days occupied by patients receiving SSI payments; ^, adjusted difference (95% CI) comparing safety-net to non-safety-net hospitals −2.3% (−4.0% to −0.6%), P<0.01. CMS, Center for Medicare and Medicaid services; ED, emergency department; E-QUAL, Emergency Quality Network (initiated launched by American College of Emergency Physicians); HCP, Hospital Compare Program; IQR, interquartile range; IQRP, Inpatient Quality Reporting Program; IVF, intravenous fluid amount administered; QI, quality improvement; SD, standard deviation.