Wells Alexis J, Sapp Alysha, Walker Danielle K, Baker Kathy A
All authors: Texas Christian University, Fort Worth, TX.
Crit Care Explor. 2025 Feb 28;7(3):e1215. doi: 10.1097/CCE.0000000000001215. eCollection 2025 Mar 1.
This scoping review aimed to understand the extent and depth of education provided on the severe sepsis and septic shock management bundle quality measure (SEP-1) to frontline clinicians to elicit insight regarding the impact on patient outcomes, the compliance rate, and any efforts to alleviate concerns about clinical judgment challenges with SEP-1.
Seven databases were used: ProQuest, EBSCO Host, Embase, Web of Science, PubMed, MEDLINE, and CINAHL for studies published in 2015 and later using key terms related to sepsis and SEP-1 quality measure.
Two independent reviewers selected studies that mentioned the Centers for Medicare and Medicaid Services SEP-1 and included education to frontline clinicians on the quality measure as one of the interventions.
Data extraction included study design, publication type, what was educated to frontline clinicians, Bennet and Bennet's "depth of knowledge" through education provided, and any mention of patient outcomes and change in SEP-1 compliance rate from the study.
The initial search yielded 493 articles. After screening for eligibility criteria, 20 studies were ultimately included. When evaluating what details of SEP-1 are being educated, 95% (19/20) of the studies focused on how to identify sepsis as well as the bundle elements required to pass the measure (19/20); however, the deeper details of the measure that allow clinical judgment and still pass the measure are severely lacking.
Multiple education opportunities not currently addressed in the literature may lead to improvement of the national SEP-1 compliance rate and alleviate clinician concern that the quality measure does not allow for clinical judgment. Without deeper education, this knowledge gap could be a key factor in why the quality measure national compliance rate has halted, raising calls to retire the measure prematurely.
本范围综述旨在了解针对一线临床医生提供的关于严重脓毒症和脓毒性休克管理集束质量指标（SEP-1）的教育程度和深度，以深入了解其对患者结局、依从率的影响，以及为缓解对SEP-1临床判断挑战的担忧所做的任何努力。
使用了七个数据库：ProQuest、EBSCO Host、Embase、Web of Science、PubMed、MEDLINE和CINAHL，用于检索2015年及以后发表的使用与脓毒症和SEP-1质量指标相关关键词的研究。
两名独立评审员选择了提及医疗保险和医疗补助服务中心SEP-1且将针对一线临床医生的该质量指标教育作为干预措施之一的研究。
数据提取包括研究设计、发表类型、对一线临床医生所教授的内容、通过提供的教育所达到的贝内特和贝内特的“知识深度”，以及研究中提及的任何患者结局和SEP-1依从率的变化。
初步检索产生了493篇文章。在根据纳入标准进行筛选后，最终纳入了20项研究。在评估所教授的SEP-1的具体细节时，95%（19/20）的研究关注如何识别脓毒症以及通过该指标所需的集束要素（19/20）；然而，严重缺乏能够进行临床判断且仍能通过该指标的更深入细节。
文献中目前未涉及的多种教育机会可能会提高全国SEP-1的依从率，并缓解临床医生对质量指标不允许进行临床判断的担忧。如果没有更深入的教育，这一知识差距可能是质量指标全国依从率停滞不前的关键因素，引发了过早淘汰该指标的呼声。
