1. ACM SEP-1: E ARLY M ANAGEMENT B UNDLE, S EVERE S EPSIS /S EPTIC S HOCK Numerator-Patients who received ALL of the following: Within 3 hours of presentation of severe sepsis: Initial lactate level measurement Blood cultures drawn prior to antibiotic administration Broad spectrum or other antibiotics administered AND Within 6 hours of presentation of severe sepsis: Repeat lactate level measurement only if initial lactate level is elevated AND ONLY if Septic Shock present: Received within 3 hours of presentation of septic shock: Resuscitation with 30 ml/kg crystalloid fluids

2. ACM SEP-1: E ARLY M ANAGEMENT B UNDLE, S EVERE S EPSIS /S EPTIC S HOCK AND ONLY if hypotension persists after fluid administration, received within 6 hours of presentation of septic shock: Repeat volume status and tissue perfusion assessment consisting of either: A focused exam including all of the following: Vital signs Cardiopulmonary exam Capillary refill evaluation Peripheral pulse evaluation Skin examination OR Any 2 of the following 4: Central venous pressure measurement Central venous oxygen measurement Bedside cardiovascular ultrasound Passive leg raise or fluid challenge

3. ACM SEP-1: E ARLY M ANAGEMENT B UNDLE, S EVERE S EPSIS /S EPTIC S HOCK Denominator: Inpatients age 18 or over with an ICD- 10-CM Principal or Other Diagnosis Code of Sepsis, Severe Sepsis, or Septic Shock