The Surviving Sepsis Campaign (SSC) care bundle is designed to quickly identify and treat cases of sepsis in hospital emergency departments (ED). The updated care bundle is based on 2016 guidelines and recommends a specific set of treatments that should begin within 1 hour of sepsis recognition. Under the care guidelines, arrival at triage acts as the “timestamp” from which the 1-hour treatment directive should commence.1

However, these guidelines may lead to misdiagnosis and inappropriate treatment by overburdened ED staff. In an editorial published in Annals of Emergency Medicine, Spiegel and colleagues argued that there is insufficient evidence to prove that 1-hour care bundles are associated with improved patient outcomes.1 Further, the new SSC care bundle created logistic challenges for many ED, which may delay care and put patients at a higher risk for medical complications.

Understanding the SSC 1-Hour Care Bundle

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  • The updated SSC 1-hour care bundle includes recommendations for:2
  • Measuring lactate level and re-measuring lactate if initial lactate is elevated (>2 mmol/L).
  • Obtaining blood cultures before administering antibiotics.
  • Administering broad-spectrum antibiotics.
  • Rapid administration of 30 mL/kg crystalloid for hypotension or lactate level is 4 mmol/L or higher.
  • Applying vasopressors if a patient is hypotensive during or after fluid resuscitation to maintain a mean arterial pressure of 65 mm/Hg or higher.

These guidelines represent a significant departure from previous care bundles, which allowed for 3-hour and 6-hour treatment directives.

Researchers acknowledged that the intentions in creating the new guidelines were appropriate: patients presenting with symptoms of sepsis require prompt medical evaluation, and the 1-hour care bundle aims to shorten the time between diagnosis and treatment. The researchers further recognized that rapid interventions for sepsis patients allow for improved survival rates and better treatment outcomes. However, there are several crucial limitations in the 1-hour care bundle, which may present a serious risk to certain patients and can affect the functionality of an ED.

1-Hour Care Bundles May Increase the Risk for Misdiagnosis and Overtreatment

The stress placed on ED staff in attempting to follow a 1-hour protocol may result in sepsis risk being inaccurately assessed during triage. Diagnoses of sepsis and septic shock often require an evaluation from an experienced ED clinician, however time constraints may result in triage nurses being tasked with identifying patients who are at risk for sepsis instead. This may allow for a significant percentage of patients to be categorized, inaccurately, as potential cases of sepsis.

The greater the pressure on ED staff to identify all possible sepsis cases, the greater the risk for misdiagnosis and unnecessary treatment. Researchers argued that, “…by examining only the patients later determined to have sepsis, the [SSC guideline] authors ignored patients without sepsis who were exposed to the risks associated with broad-spectrum antibiotics and large-volume fluid resuscitation.”1

This article originally appeared on Infectious Disease Advisor