​Performance improvement initiatives targeting sepsis are associated with improved patient outcomes, state the authors of the Surviving Sepsis Campaign (SSC) 2016 Guidelines for Management of Sepsis and Septic Shock; the guidelines were recently published in Intensive Care Medicine and Critical Care Medicine. Accordingly, the Surviving Sepsis Guideline panel issued a best practice statement recommending that hospitals and hospital systems implement performance improvement programs for sepsis, including sepsis screening for acutely ill, high-risk patients. This statement is accompanied by 92 other recommendations and best practice statements on the early management and resuscitation of patients with sepsis or septic shock. The guideline, now in its fourth revision, contains many changes and updated recommendations for identification and treatment of sepsis—which can strike unexpectedly and progress quickly and contributes to one in every two to three hospital deaths (see HRC Alerts, May 21, 2014). The updated guideline provides strong recommendations for numerous elements of standardized care, including antimicrobial therapy, initial fluid volume, blood pressure goals, and vasopressor choice. For example, as stated in an accompanying synopsis in JAMA, "substantial evolution has occurred in understanding the value of EGDT [early goal-directed therapy]" for sepsis; therefore, the new guideline no longer includes standard EGDT resuscitation targets and instead recommends that "sepsis-induced hypoperfusion be treated with at least 30 mL/kg of intravenous crystalloid given in 3 hours or less." A viewpoint, also published in JAMA, highlights additional changes including the recommended use of dynamic over static variables to predict fluid responsiveness and the recommendation that "antibiotics should be administered as soon as possible and within 1 hour maximum." The work of SSC is ongoing—care bundles will be updated to reflect guideline changes and will be available online later this year. Additionally, for the first time, the updated guideline does not include recommendations for treating pediatric patients with sepsis; a dedicated SSC pediatric guideline is in development with publication expected in about two years. Finally, as noted in the JAMA synopsis, "the international consensus definition of sepsis, the new guidelines, and [the Centers for Medicare and Medicaid Services] core measure requirements are unsynchronized. Thoughtful alignment is in order to ensure meaningful reporting and improve patient outcomes."

HRC Recommends: The updated guidelines' explicit call for hospitals and health systems to develop formal sepsis performance improvement programs illustrates the potential impact that risk managers and quality assurance personnel may have on this deadly condition. Risk managers should familiarize themselves with the updated guidelines and ensure that individuals in the "Who Should Read This" list have done the same. Collaboration will be required to ensure implementation of recommendations and best practices; remaining alert for the release of updated care bundles and forthcoming pediatric guidelines is also critical. Risk managers should examine sepsis prevention, recognition, and treatment in their organizations and evaluate the need for performance improvement initiatives. Components may include education for all clinicians on recognizing and treating sepsis; vigilance throughout the organization; champions and specialists in sepsis care; tools (e.g., bundles, protocols, screening tools); a swift, organized response when sepsis is suspected or diagnosed; quality improvement; feedback to clinicians; coordination within and across settings; and community outreach and patient education.