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    "system" : "urn:ietf:rfc:3986",
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    }]
  },
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  "experimental" : true,
  "date" : "2026-09-21T19:22:21+05:30",
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    "name" : "Atrius",
    "telecom" : [{
      "system" : "url",
      "value" : "https://atrius.in"
    }]
  }],
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      "url" : "https://www.sccm.org/survivingsepsiscampaign/guidelines-and-resources/hour-1-bundle"
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  }],
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  "action" : [{
    "id" : "sepsis-bundle-root",
    "title" : "Sepsis Management Bundle",
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      "type" : "named-event",
      "name" : "encounter-start"
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    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Sepsis Suspected"
      }
    }],
    "input" : [{
      "type" : "Patient",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"]
    },
    {
      "type" : "Observation",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-observation|0.1.0"]
    },
    {
      "type" : "Condition",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-encounter-diagnosis|0.1.0",
      "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-problems-health-concerns|0.1.0"]
    },
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      "type" : "Encounter",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-encounter|0.1.0"]
    }],
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    "action" : [{
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      }],
      "groupingBehavior" : "logical-group",
      "selectionBehavior" : "all",
      "action" : [{
        "id" : "sepsis-blood-cultures",
        "title" : "Blood cultures x2 (before antibiotics)",
        "priority" : "stat",
        "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-blood-culture|0.1.0"
      },
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        "id" : "sepsis-lactate",
        "title" : "Serum lactate",
        "priority" : "stat",
        "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-lactate|0.1.0"
      },
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        "id" : "sepsis-antibiotic",
        "title" : "Empiric broad-spectrum antibiotic",
        "priority" : "stat",
        "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-ceftriaxone|0.1.0"
      },
      {
        "id" : "sepsis-crystalloid",
        "title" : "IV crystalloid 30 mL/kg",
        "priority" : "stat",
        "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-iv-crystalloid|0.1.0"
      }]
    },
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      "id" : "sepsis-repeat-lactate",
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      }],
      "groupingBehavior" : "logical-group",
      "action" : [{
        "id" : "sepsis-repeat-lactate-order",
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      }]
    }]
  }]
}