Adult Community-Onset (CO) Sepsis Standardized Mortality Ratio (SMR)

From Electronic Health Records, via Fast Healthcare Interoperability Resources:

• Sex
• Age
• Admission from a facility or hospital transfer
• Patient-level physiology on admission
• Blood pressure, lactate, creatinine, platelets, white count, anion gap, hematocrit, ALT, bilirubin, sodium, albumin
• Hypothermia
• Vasopressors
• BMI

From Claims (ICD-10)

• Comorbidities
• Present on admission codes for pulmonary, genitourinary, skin
• Mechanical ventilation

From NHSN Annual Survey

• Hospital size

Routine measurement and monitoring of sepsis events enable healthcare facilities to better understand the incidence and impact of sepsis, evaluate adherence to evidence‑based practices, and identify gaps in care delivery. Tracking sepsis epidemiology and outcomes—including mortality, intensive care unit utilization, and length of hospital stay—provides critical insight into both clinical performance and system‑level processes. These data support the early identification of trends, facilitate targeted quality improvement initiatives, and allow hospitals to assess the effectiveness of sepsis screening, treatment pathways, and performance improvement programs over time.

By promoting consistent surveillance, standardized management, and outcome measurement, this sepsis measure aligns with national and international guidance that emphasizes performance improvement, monitoring, and accountability as central components of effective hospital‑based sepsis programs. The use of actionable sepsis data supports continuous improvement efforts aimed at reducing sepsis‑associated mortality, improving care reliability, and optimizing patient outcomes.

References:

• Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021;47(11):1181–1247. doi:10.1007/s00134‑021‑06506‑y.
• Centers for Disease Control and Prevention. (2025, January 31). Hospital sepsis program core elements. https://www.cdc.gov/sepsis/hcp/core-elements/index.html

Recommendations:

1. Healthcare facilities should implement systematic screening processes to support early identification of sepsis and septic shock among acutely ill and high‑risk patients. Screening approaches should be integrated into routine clinical workflows and designed to promote rapid clinical evaluation when sepsis is suspected, recognizing that early identification is critical to improving outcomes.
2. Facilities should establish standard operating procedures for the timely management of sepsis and septic shock that support prompt clinical evaluation following a positive screening result, early initiation of appropriate antimicrobial therapy, rapid assessment of hemodynamic status, and timely escalation of care when clinically indicated. Clinical management pathways should be aligned with evidence‑based guidelines and promote ongoing reassessment and modification of therapy based on the patient’s clinical response and evolving clinical data.

References:

• Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021;47(11):1181–1247. doi:10.1007/s00134‑021‑06506‑y.
• Centers for Disease Control and Prevention. (2025, January 31). Hospital sepsis program core elements. https://www.cdc.gov/sepsis/hcp/core-elements/index.html

Hospital Stay: NHSN defines a hospital stay to be inclusive of any: (a) ED/OBS encounters, (b) inpatient admissions, or (c) ED/OBS encounters that lead to inpatient admissions (within 1 hour of ED/OBS encounters).

Inpatient admission: For NHSN reporting purposes, the ‘date admitted to the facility’ is hospital day (HD) 1. NHSN defines an inpatient as any patient cared for or housed on an inpatient location. Local status may differ from NHSN definition; all days spent in an inpatient unit, regardless of local admission status and/or billing status are included in the counts of admissions and inpatient days. For NHSN reporting purposes, the date admitted to the facility is the calendar date that the patient physically locates to an inpatient location.

Present on Admission (POA): Diagnosis that is present on the day of admission to an inpatient location (calendar day 1), the 2 days before admission, or the calendar day after admission (POA time period).

Facility Days: Facility days are used to count days present at the facility during a hospital stay. The first day of a Hospital Stay is Facility Day 1.

Measurement Period: Time period used for metric calculation

CO Sepsis (COS): Community-Onset Sepsis

HO Sepsis (HOS): Hospital-Onset Sepsis

Inpatient Mortality:  Patients who die during the hospital stay or are discharged to hospice.

Evidence of organ dysfunction may include abnormalities in laboratory results, initiation of supportive therapies, or other indicators consistent with acute physiologic deterioration. Examples may include elevated serum lactate, abnormal renal or hepatic laboratory values, initiation of vasopressor therapy, or the initiation of mechanical ventilation. These indicators should be interpreted within the clinical context and in accordance with the Adult Sepsis Event surveillance definition.

Timing relationships between infection indicators and organ dysfunction indicators are used to determine whether a qualifying Adult Sepsis Event has occurred. Event identification is based on the temporal association of these elements as documented in the electronic health record.

Clinical, laboratory, and medication administration data used to identify Adult Sepsis Events should be available within the electronic health record and exposed using the FHIR Release 4 standard. Relevant data elements should be codified using HL7 standardized terminology to support consistent identification of eligible events across systems.

This version of the measure uses the Acute Care Hospital (ACH) Monthly Reporting Profiles in  the NHSN dQM Content Package IG. Please refer to the NHSN FHIR Portal for additional information on FHIR-based digital quality measures.

• Patients <18 years of age
• Length of hospitalization >120 days
• Patients with prior enrollment in hospice
• Patients that transferred to another acute care hospital