State Health Policies Reduce Sepsis Cases

March 07, 2025 | Erin Laird

Sepsis—the body’s extreme immune system response to infection that can lead to shock, organ failure, and death—affects more than 1.7 million U.S. adults; worldwide, the number jumps to 30 million people. Sepsis can happen following almost any infection but most often occurs in response to those in the gastrointestinal tract, lungs, skin, or urinary tract. At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice. While most often affecting people with weakened immune systems (e.g., adults 65 years and older, people with chronic conditions or recent severe illnesses), sepsis can afflict anyone.

Sepsis has received federal attention in recent years. In the Fiscal Year 2023 Omnibus Spending Bill, the U.S. Congress directed the Agency for Healthcare Research and Quality to study sepsis-related illnesses, hospital readmissions and deaths, and the impact of pandemic-related changes in the health care system. In September 2024, Agency for Healthcare Research and Quality reported ongoing disparities in sepsis incidence and outcomes among under resourced or underutilized hospitals, as well as higher death rates and worse sepsis outcomes among Black and Hispanic populations.

Reducing the rates of sepsis and improving patient outcomes require a coordinated approach. Health care providers play a key role through direct patient care, including recognizing the symptoms, and implementing targeted antimicrobial therapy with routinized opportunities to evaluate the need for continued administration of antimicrobials. They also contribute to surveillance efforts by reporting to public health agencies and leading facility-level surveillance. Through surveillance and policy, public health stakeholders can ensure facility-level efforts occur across the continuum of care and that they are based on evidence-based best practices. Further, public health stakeholders can take a critical view upstream to track and prevent infections that cause sepsis in the first place. 

Improving Early Recognition and Timely Treatment

In recent years, multiple states have introduced bills to promote early recognition for sepsis, a strategy that has been successful in many jurisdictions. In 2013, the New York State Department of Health implemented "Rory's Regulations,” which were named for 12-year-old Rory Staunton who died of sepsis in 2012. The regulations require all acute care hospitals in the state to develop and implement protocols for timely recognition and treatment of sepsis. New York was the first U.S. state to enact mandatory sepsis protocol requirements, which are credited with a measurable reduction in sepsis deaths. Building on this success, in July 2023 New York enacted A 6030, which allows registered nurses in hospitals to administer tests and IV lines for patients meeting severe sepsis and septic shock criteria (among other conditions) before attending to a physician’s direct order.

Also in 2023, Rhode Island enacted SB 283, amending its existing laws on licensing of health care facilities to require protocols for early recognition and treatment of patients with sepsis. This amendment requires the department of health to share information on best practices related to sepsis and septic shock treatment and requires each licensed hospital to align their policies and procedures with these practices. In addition, Utah enacted SB 38, which allows acute care hospital inspectors to request a copy of a hospital’s sepsis protocols as a component of their inspection.

In 2024, at least three additional states enacted legislation aimed at improving timely recognition and treatment of sepsis:

• Kentucky (HB 477) requires the Department of Medicaid Services and any department-contracted managed care organization to deliver services that apply clinical criteria for sepsis—a medical provider diagnosis for suspected or confirmed source of infection as well as at least two symptoms that indicated inflammatory response syndrome—to promote early identification and treatment.
• Maryland (HB 84/SB 332) requires every hospital and urgent care center in the state to implement an evidence-based protocol for early recognition and treatment of sepsis, severe sepsis, or septic shock by January 1, 2025 that complies with CDC guidelines. The bill also requires periodic protocol training, as well as requiring updated training if there are substantive changes.
• As part of a comprehensive bill modernizing the state’s emergency medical services system, Oregon (HB 4081) created a permanent Time-Sensitive Medical Emergencies Advisory Committee as part of the Emergency Medical Systems Advisory Board. The committee provides technical assistance, advice, and recommendations on improving care for time-sensitive medical emergencies, including sepsis.

Currently, New Jersey (A 2455/S 1151) and Oklahoma (HB 1686) are considering legislation requiring hospitals to establish and implement evidence-based protocols for early identification and treatment of sepsis.

In addition to state actions to combat sepsis, the Centers for Medicare and Medicaid Services established the Severe Sepsis and Septic Shock Management Bundle (SEP-1) in 2015 and included this bundle as a pay-for-performance measure in the Hospital Value-Based Purchasing program in 2023. However, this protocol has been challenged by groups that say it encourages overuse of broad-spectrum antibiotics and should be revised to prioritize diagnostic strategies, care of sepsis patients throughout hospitalization and rehabilitation for sepsis survivors. Further, a new meta study found that SEP-1 compliance did not affect mortality rates among patients with sepsis.

Early detection and treatment of sepsis is key to preventing severe outcomes, including death. States can promote this strategy by enacting laws that require health care facilities to implement mandatory protocols for timely recognition and treatment of sepsis. ASTHO will continue to monitor and report on this important issue.

Special thanks to Maggie Davis for her contributions to this Health Policy Update.