Critical CareIntensive CareSepsisSMACCUncertainty at the centre of sepsis

Uncertainty at the centre of sepsis by Hallie Prescott

Sepsis is a common and deadly condition, but diagnosis in not always knowable in real-time.

The optimal treatment during times of diagnostic uncertainty differs across patients. Despite this reality, sepsis performance is uniformly assessed and reported for a population knowable only in retrospect—the patients ultimately judged to have sepsis at hospital discharge.

This limits effective audit and feedback to incentivise clinician behaviour.

Personalised, real-time assessments of a patient’s risk of death and likelihood of infection could instead be used to guide treatment recommendation and performance assessment.

Clinicians and health systems could be judged on whether their responses are appropriately calibrated given the urgency of the situation.

Were antibiotics prescribed at an appropriate time given the urgency of the patient’s clinical status?

With the information available, were the best treatment decisions made?

Did treatment plans change as new data became available?

Organising treatment recommendations and performance assessment by risk of death and likelihood of infection could optimise sepsis care.

Uncertainty at the centre of sepsis by Hallie Prescott

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Hallie Prescott

Dr. Hallie Prescott is an Assistant Professor in Pulmonary & Critical Care Medicine at the University of Michigan and staff physician at the Ann Arbor Veterans Affairs Hospital. She leads grants on post-sepsis morbidity and hospital performance measurement from the US National Institutes of Health and the US Department of Veteran’s Affairs. She is an expert in long-term outcomes and recovery after sepsis. She is a vice-chair of the Surviving Sepsis Campaign guidelines, council member of the International Sepsis Forum, and a former ANZICS Intensive Care Global Rising Star fellow (2015).