To ensure rapid completion of the 3-hour bundle, it is critical that providers are able to rapidly identify septic patients. At present, however, there is no standard tool for early sepsis identification and hospitals differed in their approach to sepsis recognition in the present trial. The SIRS criteria misses ~10-15% of patients with SIRS-negative sepsis (Kaukonen, 2015). In addition, the SIRS criteria are not specific and may result in the inappropriate extension of sepsis protocols to non-septic populations. The Sepsis III qSOFA criteria are not sensitive for sepsis and are focused on identifying patients at risk of organ injury (Seymour, 2016).
In the present manuscript, Seymour suggests that one potential explanation for the effect of time-to-bundle completion on mortality is that "clinicians who decide more quickly to measure the serum lactate level may identify heretofore unrecognized shock." The role of lactate in sepsis recognition has also not been adequately defined.
How should hospitals considering implementing similar 3-hour bundles identify patients with sepsis? Should lactate measurement be standard for all patients with suspected infection?
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