OBJECTIVES: Assess the severe sepsis diagnosis and management practices based on the SSC guidelines and quality indicators.Determine the case severity level and outcomes of severe sepsis in an inner city hospital setting.Ascertain the average direct cost of severe sepsis hospitalization in this setting. METHODS: Using an explanatory cross-sectional evaluation design, demographic, administrative, clinical and laboratory data of all patients with physician- diagnosed sepsis admitted during March – May 2007 were reviewed. The SSC-IHI severe sepsis screening/chart measurement tools and quality indicators were used for data collection and performance assessment respectively. Process measures were; time-to-blood culture, blood culture-antibiotic sequence, time-to-antibiotic, CVP goal, CV Oxygen saturation goal, Low-dose steroid administration, Drotrecogin Alfa administration, and glycemic control goal. Outcome measures were; In-hospital mortality, ICU mortality, ICU LOS, hospital LOS and hospital discharge location. RESULTS: Of 58 patients, 24 (41%) met the criteria for severe sepsis with an average APACHE III score of 69±31.  There was a score of 60% on four (50%) of the eight process measures and <35% on the other four. In-hospital mortality of 25% (16.7% for ICU) compared favorably with 28.6% national. Average hospital LOS (9.1 ± 6.5 days) and ICU LOS (3.3 ± 3.4 days) were within expected benchmarks. Discharge to skilled nursing facility was 21%. Compared to those who did not meet severe sepsis criteria, the mortality rates were lower (25% vs. 29.1%) and the LOS values higher (9.1 vs. 8.4 days) in the severe sepsis group. The average direct cost of severe sepsis hospitalization was $30,061, mean daily cost of $3303. CONCLUSIONS: Variation in adoption of the SSC-IHI guideline is apparent. Though, severe sepsis outcomes are above average, opportunities for process improvement that should enhance outcomes in this setting exist.