Your clinicians know the sepsis bundle. Most have trained on it for years. So why does the national SEP-1 compliance average sit at 64%?
The gap is visibility. A nurse can’t complete a step she doesn’t know is overdue, for a patient who transferred off her unit an hour ago.
Below is the sepsis bundle checklist, followed by the fallouts: where SEP-1 cases actually fail.
Time zero: where failures begin
Every deadline runs from time zero. Under SEP-1, time zero is when the last of three criteria is met within a six-hour window: suspected infection, two or more systemic inflammatory response syndrome (SIRS) criteria, and organ dysfunction. A clinician documenting severe sepsis also starts the clock.
If your team can’t see when the clock started, nobody knows when it runs out. AWARE – Sepsis DART™ calculates time zero automatically and displays it on every flagged patient.
Within 3 hours: severe sepsis
☐ Measure initial lactate
☐ Draw blood cultures before antibiotics
☐ Administer broad-spectrum antibiotics
Within 3 hours: add for septic shock (hypotension or lactate of 4 mmol/L or higher)
☐ Administer 30 mL/kg crystalloid fluids
Within 6 hours
☐ Repeat lactate if the initial result was above 2 mmol/L
☐ Start vasopressors if hypotension persists after fluids (septic shock)
☐ Document a repeat volume status and tissue perfusion assessment by a physician, APN, or PA (septic shock)
SEP-1 is all-or-none. Miss one applicable requirement, and the case fails, even if every other step was done.
Sepsis guidelines vs. the SEP-1 measure
The Surviving Sepsis Campaign’s 2026 guidelines recommend starting antibiotics immediately, ideally within one hour, for possible, probable, or definite septic shock, and for probable or definite sepsis without shock. When sepsis is only possible and the patient is not in shock, they suggest a rapid assessment first, then antibiotics within three hours of first suspicion if concern persists.
Clinicians follow the guidelines. Quality teams are scored on SEP-1. Your workflow has to satisfy both.
Where SEP-1 cases fall out
Sepsis coordinators call failed cases fallouts. Six patterns to watch:
- Unclear time zero. The clock started, but no one could see it.
- Cultures after antibiotics. Both happened, in the wrong order.
- Repeat lactate ordered, never collected. The order was placed, but the draw never happened within six hours.
- Fluids withheld, reason not documented. The decision may have been sound, but the chart doesn’t show the clinical justification, so the case fails abstraction.
- Missing reassessment documentation. A note exists, but it doesn’t meet the measure’s required elements.
- Lost at transfer. The ED team started the bundle, and the floor team didn’t know what was left.
A hospital can deliver appropriate care and still fail SEP-1 if the chart can’t prove it. These failures have different causes, but many share one gap: no one had a live view of bundle status. Sepsis DART shows each step as done, pending, or overdue, escalates the overdue ones to the responsible clinician, and keeps the status with the patient through every transfer.
What a SEP-1 fallout costs you
CMS scores SEP-1 under Hospital Value-Based Purchasing, and your Medicare payment is tied to CMS Value-Based Purchasing performance. For FY 2027, which scores 2025 performance, CMS set the SEP-1 achievement threshold at 61.8% and the benchmark at 86.1%.
A hospital earns points for achievement against those national levels or for improvement over its own baseline, whichever is higher. Every applicable case that fails SEP-1 lowers your rate and pulls you further from the benchmark.
A checklist tells your team what to do. It can’t tell them what is overdue on a patient who left their unit an hour ago.
See Sepsis DART turn this checklist into a live view for every patient. Book a walkthrough
