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Sepsis is a leading cause of death and suffering, afflicting 1.7 million adults annually in the USA and contributing to over 250 000 deaths. 1 The high burden of sepsis has catalysed numerous performance improvement and policy initiatives, including mandatory sepsis protocols in a growing number of US states, the Centers for Medicare and Medicaid Services’(CMS)‘SEP-1’measure, and WHO’s resolution declaring sepsis a global health priority. 2 Hospitals around the world are dedicating considerable resources to improving sepsis recognition and compliance with treatment bundles. However, accurately measuring the impact of sepsis quality improvement efforts is challenging. The core problem is that diagnosing sepsis involves considerable subjectivity. 3 Sepsis is a heterogeneous syndrome without a pathological gold standard. It is defined as infection leading to organ dysfunction, 4 but it is often unclear …