Failures of Sepsis Screening Algorithms and How to Identify Those Patients Before They Descend the Septic Spiral Staircase of Death

As we prepare for the impending addition of SEP-1 to CMS’ Hospital Value Based Purchasing for FY 2026, many hospitals have aggressively ratcheted up their sepsis screening and sepsis alert algorithms. The nearly universal foundation for sepsis screening algorithms involves the flawed SIRS criteria which are intended to have high sensitivity at the expense of poor specificity. A landmark study in 2015 (Kaukonen et al, NEJM) highlighted the disappointing SIRS sensitivity (88%) even in patients who were septic and had associated organ failure. In this study, SIRS was even less sensitive in Geriatric patients, which is not surprising as there is no SIRS adaptation for individual patient variables such as age or concurrent use of a rate controlling medication. In this track session, I will use a cased based format to illustrate why certain patient populations and specific pathologies are at higher risk of sepsis and are less likely to trigger any aggressive sepsis alerts designed to prevent downstream morbidity and mortality. I will cover the vulnerable prisoner population, tickborne illness, and skin and soft tissue infections of the perineal area as just a few examples of patient presentations that require vigilance to prevent hypotension in the waiting room as the very first sign that the patient is much sicker than had been assessed. Hospitals are preparing for Hospital Value Based Purchasing with SEP-1 and their objective is to check the boxes required to avoid financial consequences. I will prepare the physician to focus on patient-centered outcomes in those patients who will not be caught in the sepsis screening net.