Code Sepsis: Enhancing Early Detection and Intervention

Sepsis is a common but often misunderstood medical emergency, resulting from the body’s dysregulated immune response to an infection. Affecting nearly 1.7 million Americans annually and with a mortality rate that increases by roughly 8% for every hour the condition goes undiagnosed, rapid and accurate diagnosis and medical intervention is required.

When time is of the essence, a Code Sepsis protocol is activated to rapidly mobilize resources and deliver expedited treatment to patients with suspected sepsis. However, traditional Code Sepsis protocols often rely on non-specific clinical criteria —such as SIRS — which may overestimate or potentially miss the signs of immune dysregulation, delaying clinically appropriate intervention. Integrating rapid diagnostic data into Code Sepsis protocols can enhance early detection and intervention.

What Is Code Sepsis and Why Is It Important?

Like Code Blue or Code Stroke, Code Sepsis is an internal hospital notification that identifies a patient with the potential for developing septic shock—a fatal diagnosis if not caught early.

Where there are standardized sepsis protocols, there is a decrease in sepsis-related mortality by almost 23%. Standardization is the path to high reliability, as standardized, evidence-based practice ensures that a patient with the same diagnosis receives the same treatment, every time. It creates “muscle memory” for nurses and providers to treat every sepsis patient in the same manner, while allowing for specialized care based on the source of infection.

One valuable tool to assist in caring for these critical patients is a standardized checklist:

Code Sepsis Checklist for Septic Shock

• Activation criteria may include the following:
  • SIRS Criteria
  • Suspected or Confirmed Source of Infection
  • End Organ Dysfunction
  • Initial Lactic Acid of 4.0 or greater
  • Persistent hypotension (2 SBP less than 90 within 1 hour of the 30ml/kg IV fluid bolus)
  • Provider documentation of septic shock
• Once the patient meets the criteria for septic shock, the following is typically performed:
  • Code sepsis is activated
  • Initial lactic acid collected (If not previously obtained)
  • Blood cultures (2 sets) collected prior to antibiotic administration
  • IV Fluids (30ml/kg) over 15-30 minutes
  • Broad spectrum antibiotics (Goal: Administer within 30 minutes of order time)
  • Repeat lactic acid collected (after IV fluid administration)
  • Focused reassessment after IV fluid administration
  • Vasopressors, if needed, for pressure support

What Does Sepsis Alert Mean in a Hospital?

As previously described, emergency departments frequently call codes to alert and summon resources to a patient in need. At most institutions, a Sepsis Alert is distinct from a Code Sepsis. Sepsis alerts are typically generated within the hospital’s electronic health record (EHR) system during triage and sent directly to the designated care team. It is an early-warning mechanism that flags patients for further evaluation. In contrast, a Code Sepsis—used when there is a strong suspicion or confirmation of sepsis—triggers a broader notification to mobilize a full-scale, coordinated response from the clinical team.

What Are the Limitations of Traditional Sepsis Detection Practices?

Traditional sepsis detection practices—such as those outlined in the CMS SEP-1 guidelines—rely heavily on clinical criteria and subjective data. For a patient to meet severe sepsis under SEP-1, they must meet at least two abnormal vital signs indicating systemic inflammatory response to insult/infection (SIRS criteria) , have a suspected or confirmed source of infection, and exhibit one sign of end-organ dysfunction within a defined time window (typically 6 hours before to 3 hours after initiation of treatment). In some instances, a diagnosis of severe sepsis is based solely on physician documentation—even when objective criteria are not fully met. Consider a scenario where a patient presents with a heart rate of 91, a respiratory rate of 21, an antibiotic order for a toe infection, and a total bilirubin of 2.1. Such findings may be incidental (for example, related to an underlying condition like cirrhosis), yet they can still trigger the 3-hour sepsis clock despite a low overall suspicion of sepsis. This reliance on subjective clinical parameters can lead to both false alarms and missed diagnoses, underscoring a key limitation of traditional sepsis detection practices. Newer diagnostic approaches aim to reduce this subjectivity by delivering rapid, objective, risk-stratified data. For example, the IntelliSep test yields a blood-to-score turnaround time of approximately 8 minutes and categorizes patients into distinct risk bands (e.g. Band 1, Band 2, Band 3) providing clear, actionable information. Such data can empower clinicians to more confidently rule in or rule out sepsis, ensuring that patients receive timely, targeted interventions while reducing unnecessary treatments. This objective, rapid risk stratification provides the clarity needed to differentiate true sepsis from conditions that merely mimic its presentation.

How Cytovale’s IntelliSep Can Enhance Code Sepsis Protocols

IntelliSep is designed to integrate seamlessly into existing sepsis protocols without disrupting established workflows. Whether incorporated into nurse-driven order sets in triage or provider-initiated protocols, it provides an objective, rapid sepsis risk score that complements traditional clinical criteria.
When integrated into a Code Sepsis protocol, the test can clarify a patient’s risk status. For instance, a high-risk result (e.g., a Band 3 score) may prompt immediate activation of a Code Sepsis, while a low-risk result (e.g., a Band 1 score) supports the decision of a healthcare provider to rule out sepsis and pursue alternative diagnoses. A key advantage of IntelliSep is its ability to identify the “sneaky 3’s” – patients who lack overt clinical signs of sepsis yet exhibit subtle cellular-level immune dysregulation. Detecting these sepsis cases early provides crucial clarity, enabling more precise risk stratification and ensuring that resources are deployed promptly.

By shifting sepsis detection from a predominantly subjective process to one supported by rapid, objective data, hospitals can enhance early intervention, optimize resource utilization, and improve patient outcomes.