Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
I would think that one of the criteria for lower level care for those patients would be the ability to get q 2 hours vital signs for at least 24 hours, and do serial lactates q 6 hours for 24 hours as well. If staffing or new technology in a step-down or telemetry would support this, then deterioration would be able to be picked up more quickly and it should be safe to admit the patient there, rather than ICU. Martie Martie Mattson, RN, MSN, CNS, CCRN(a) Critical Care Consultant and Educator mailto:mattsonconsult...@comcast.net mattsonconsult...@comcast.net (415) 412-2364 From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Mary Draper Sent: Friday, September 27, 2013 7:32 AM To: Jamie Roney Cc: sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? If they are hemodynamically stable and have responded to fluids, they could go to a telemetry unit but those nurses have 4-5 patients and subtle changes leading to instability can get missed. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 tel:(925)%20674-2045 Cell (925) 451-8792 tel:(925)%20451-8792 Fax (925) 674-2373 tel:(925)%20674-2373 mailto:mary.dra...@johnmuirhealth.com mary.dra...@johnmuirhealth.com On Sep 27, 2013, at 7:05 AM, Jamie Roney jro...@covhs.org mailto:jro...@covhs.org wrote: Dr. Townsend, Is there a sepsis specific risk/treatment stratification tool available to assist in answering your question of placement in a possible lower level of care? Or is there a tool to assist with septic patients who can be discharged home versus admitted due to probable deterioration into severe sepsis? Thank you, Jamie Jamie Roney, BSN, RN-BC, BSHCM, CCRN COVENANT HEALTH SEPSIS COORDINATOR Be a yardstick of quality. Some people aren't used to an environment where excellence is expected. ~Steve Jobs 3615 19th Street, Lubbock, TX 79410 T: (806) 725-4689C: (806) 773-1914 www.covenanthealth.org http://www.covenanthealth.org .. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org mailto:sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM To: 'sepsisgroups@lists.sepsisgroups.org mailto:sepsisgroups@lists.sepsisgroups.org ' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org mailto:towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org mailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org mailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
If they are hemodynamically stable and have responded to fluids, they could go to a telemetry unit but those nurses have 4-5 patients and subtle changes leading to instability can get missed. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045tel:(925)%20674-2045 Cell (925) 451-8792tel:(925)%20451-8792 Fax (925) 674-2373tel:(925)%20674-2373 mary.dra...@johnmuirhealth.commailto:mary.dra...@johnmuirhealth.com On Sep 27, 2013, at 7:05 AM, Jamie Roney jro...@covhs.orgmailto:jro...@covhs.org wrote: Dr. Townsend, Is there a sepsis specific risk/treatment stratification tool available to assist in answering your question of placement in a possible lower level of care? Or is there a tool to assist with septic patients who can be discharged home versus admitted due to probable deterioration into severe sepsis? Thank you, Jamie Jamie Roney, BSN, RN-BC, BSHCM, CCRN COVENANT HEALTH SEPSIS COORDINATOR Be a yardstick of quality. Some people aren't used to an environment where excellence is expected. ~Steve Jobs 3615 19th Street, Lubbock, TX 79410 T: (806) 725-4689C: (806) 773-1914 www.covenanthealth.orghttp://www.covenanthealth.org .. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.orgmailto:sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM To: 'sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.orgmailto:towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.orgmailto:Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
I have to agree with Mary Ann. Our hospital tracks admissions that are transferred from an inpatient unit to the ICU within 24 hours of admission. The nurse to patient ratio on inpatient units does not always lend itself to frequent enough assessments to catch patients early on in the game. We try to advocate for the ICU if the patient is in severe sepsis. When we talk about being stabilized in the ED we are often giving a lot of fluids - something that the inpatient nurses do not have orders for and are not comfortable with. I have encouraged my ED staff to cut the patient's fluid back to the rate that has been ordered on the inpatient orders. If there is change in VS they then have something to go to the hospitalist with to support the need for ICU. Juanita Fernandes, RN, BSN, CEN Emergency Department Nurse Educator Concord Hospital 250 Pleasant Street Concord, New Hampshire 03301 (603) 227-7000 ext. 3138 Pager (603) 221-1104 On 3/18/2013 at 12:19 PM, Daly, Mary Ann dal...@sutterhealth.org wrote: Since I have gotten some feedback regarding my post about our admission to ICU ratio to mortality I wanted to clarify. I wasn't suggesting that every patient in every hospital with severe sepsis requires an ICU admission. Just stating how our data supports this for our institutions (6 in all) Perhaps if we had more optimal care in other areas of the hospital the necessity would be less for ICU That said, I am reading many posts about 'good clinical medicine' and deciding the disposition of the patient on a case-by-case basis. This is akin to how we treated cardiac patients (and in some cases still do) i.e. deciding the extent of cardiac involvement based on 'how the patient looks'. The problem with placing patients who has responded to initial therapy on the floors - is the level of surveillance and the rapid response to timely assessments = all done more effectively in the ICU setting. I would rather admit a stable patient to ICU for 6-12 hours then transfer knowing that stability has been maintained then wait for a patient to decompensate on the floors (data shows patients are typically in organ failure for 12 hrs to 2-3 days before they are transferred) which confers an increased mortality risk. This is supported by the SSC data base for the US and Europe. Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: dal...@sutterhealth.org Blackberry: 916.200.5604 Office: 916.614.6370 ý You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of peggy.siene...@hcahealthcare.com Sent: Friday, March 15, 2013 9:05 AM To: Townsend, Sean, M.D.; sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Sean, My answer is NO...they do not all need ICU. I think it is very patient specific and determined by how close to the edge they arefor lack of a better way to say it right now. The numbers do not ALWAYS reflect the patient statusWe put some on the medical unit that seem to be stable after ED treatmentsure, a tiny few may end up being RRT'ed later...but for the most partthose with SS that are admitted to the floor instead of ICU seem to be OK once they get the antibiotic and fluids in ED and stabilize rather quickly. I would never treat it as a black and white decision with strictly numbers and test results. One has to see the patient and know the patient...including co-morbidities and response to the treatment you have initiated already. Just my 2 cents. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 2:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Thank you Mary Ann, The 'ICU for a while' brings up a good point. Again it's not a choice. DRG 870 SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS DRG 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC DRG 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W/O MCC If following the protocol in the Emergency Department locks in the words Severe Sepsis, the DRG choices are fairly few. Since CMS defines Severe Sepsis as a Major Complication and Comorbid Condition (No real way to reach DRG 872 anyway) it's really not much of a choice. Link below. http://www.scribd.com/fullscreen/49063853?access_key=key-pc7882f7c4p9l3y76yj If you want to get reimbursed for treating Severe Sepsis then you'll have to treat it the way CMS is expecting it done. Matt Reavill -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Daly, Mary Ann Sent: Monday, March 18, 2013 11:19 AM To: 'peggy.siene...@hcahealthcare.com'; Townsend, Sean, M.D.; 'sepsisgroups@lists.sepsisgroups.org' Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Since I have gotten some feedback regarding my post about our admission to ICU ratio to mortality I wanted to clarify. I wasn't suggesting that every patient in every hospital with severe sepsis requires an ICU admission. Just stating how our data supports this for our institutions (6 in all) Perhaps if we had more optimal care in other areas of the hospital the necessity would be less for ICU That said, I am reading many posts about 'good clinical medicine' and deciding the disposition of the patient on a case-by-case basis. This is akin to how we treated cardiac patients (and in some cases still do) i.e. deciding the extent of cardiac involvement based on 'how the patient looks'. The problem with placing patients who has responded to initial therapy on the floors - is the level of surveillance and the rapid response to timely assessments = all done more effectively in the ICU setting. I would rather admit a stable patient to ICU for 6-12 hours then transfer knowing that stability has been maintained then wait for a patient to decompensate on the floors (data shows patients are typically in organ failure for 12 hrs to 2-3 days before they are transferred) which confers an increased mortality risk. This is supported by the SSC data base for the US and Europe. Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: dal...@sutterhealth.org Blackberry: 916.200.5604 Office: 916.614.6370 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of peggy.siene...@hcahealthcare.com Sent: Friday, March 15, 2013 9:05 AM To: Townsend, Sean, M.D.; sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Sean, My answer is NO...they do not all need ICU. I think it is very patient specific and determined by how close to the edge they arefor lack of a better way to say it right now. The numbers do not ALWAYS reflect the patient statusWe put some on the medical unit that seem to be stable after ED treatmentsure, a tiny few may end up being RRT'ed later...but for the most partthose with SS that are admitted to the floor instead of ICU seem to be OK once they get the antibiotic and fluids in ED and stabilize rather quickly. I would never treat it as a black and white decision with strictly numbers and test results. One has to see the patient and know the patient...including co-morbidities and response to the treatment you have initiated already. Just my 2 cents. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 2:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Mary Ann, The clinical decisions should be driven by the Severe sepsis screening tool, not just whether the patient looks good. Step down units in organizations that allow severe sepsis to be admitted to step-down usually have severe sepsis orders that trigger aggressive fluid management and transfer if the patient's lactate trends up or BP trends down. If the process is thought out and education is broad and accountability is established, severe sepsis can definitely be safely managed outside of the ICU. Many severe sepsis patient are admitted to the ICU based on what the organ failure is and ICU criteria. The early identification, early antibiotic, and monitoring for progression in patients without lactic acidosis or hypotension can be effectively achieved outside ICU. So case by case basis is not based on clinician opinion, but an established protocol/process determined by our sepsis team. Patty -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Daly, Mary Ann Sent: Monday, March 18, 2013 11:19 AM To: 'peggy.siene...@hcahealthcare.com'; Townsend, Sean, M.D.; 'sepsisgroups@lists.sepsisgroups.org' Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Since I have gotten some feedback regarding my post about our admission to ICU ratio to mortality I wanted to clarify. I wasn't suggesting that every patient in every hospital with severe sepsis requires an ICU admission. Just stating how our data supports this for our institutions (6 in all) Perhaps if we had more optimal care in other areas of the hospital the necessity would be less for ICU That said, I am reading many posts about 'good clinical medicine' and deciding the disposition of the patient on a case-by-case basis. This is akin to how we treated cardiac patients (and in some cases still do) i.e. deciding the extent of cardiac involvement based on 'how the patient looks'. The problem with placing patients who has responded to initial therapy on the floors - is the level of surveillance and the rapid response to timely assessments = all done more effectively in the ICU setting. I would rather admit a stable patient to ICU for 6-12 hours then transfer knowing that stability has been maintained then wait for a patient to decompensate on the floors (data shows patients are typically in organ failure for 12 hrs to 2-3 days before they are transferred) which confers an increased mortality risk. This is supported by the SSC data base for the US and Europe. Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: dal...@sutterhealth.org Blackberry: 916.200.5604 Office: 916.614.6370 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of peggy.siene...@hcahealthcare.com Sent: Friday, March 15, 2013 9:05 AM To: Townsend, Sean, M.D.; sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Sean, My answer is NO...they do not all need ICU. I think it is very patient specific and determined by how close to the edge they arefor lack of a better way to say it right now. The numbers do not ALWAYS reflect the patient statusWe put some on the medical unit that seem to be stable after ED treatmentsure, a tiny few may end up being RRT'ed later...but for the most partthose with SS that are admitted to the floor instead of ICU seem to be OK once they get the antibiotic and fluids in ED and stabilize rather quickly. I would never treat it as a black and white decision with strictly numbers and test results. One has to see the patient and know the patient...including co-morbidities and response to the treatment you have initiated already. Just my 2 cents. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 2:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Since I have gotten some feedback regarding my post about our admission to ICU ratio to mortality I wanted to clarify. I wasn't suggesting that every patient in every hospital with severe sepsis requires an ICU admission. Just stating how our data supports this for our institutions (6 in all) Perhaps if we had more optimal care in other areas of the hospital the necessity would be less for ICU That said, I am reading many posts about 'good clinical medicine' and deciding the disposition of the patient on a case-by-case basis. This is akin to how we treated cardiac patients (and in some cases still do) i.e. deciding the extent of cardiac involvement based on 'how the patient looks'. The problem with placing patients who has responded to initial therapy on the floors - is the level of surveillance and the rapid response to timely assessments = all done more effectively in the ICU setting. I would rather admit a stable patient to ICU for 6-12 hours then transfer knowing that stability has been maintained then wait for a patient to decompensate on the floors (data shows patients are typically in organ failure for 12 hrs to 2-3 days before they are transferred) which confers an increased mortality risk. This is supported by the SSC data base for the US and Europe. Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: dal...@sutterhealth.org Blackberry: 916.200.5604 Office: 916.614.6370 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of peggy.siene...@hcahealthcare.com Sent: Friday, March 15, 2013 9:05 AM To: Townsend, Sean, M.D.; sepsisgroups@lists.sepsisgroups.org Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Sean, My answer is NO...they do not all need ICU. I think it is very patient specific and determined by how close to the edge they arefor lack of a better way to say it right now. The numbers do not ALWAYS reflect the patient statusWe put some on the medical unit that seem to be stable after ED treatmentsure, a tiny few may end up being RRT'ed later...but for the most partthose with SS that are admitted to the floor instead of ICU seem to be OK once they get the antibiotic and fluids in ED and stabilize rather quickly. I would never treat it as a black and white decision with strictly numbers and test results. One has to see the patient and know the patient...including co-morbidities and response to the treatment you have initiated already. Just my 2 cents. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 2:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
From our recent study on the coding of severe sepsis cases, in whittaker s, et al CCM 2013, where our gold standard reference group was all ED pt's prospectively screened for severe sepsis, the proportion of severe sepsis cases that were cared for in the ICU vs floors was ~ 50%. As was previously stated, the icu cohort are primarily EGDT eligible, hemodynamically unstable, pt's as well as those with acute respiratory failure that complicates or follows presentation. Of note, this study did not include severe sepsis cases that developed in-house, but there is no reason to think that the care venue would differ in these cases. Hope this helps. Barry Fuchs Sent from my iPhone On Mar 17, 2013, at 11:51 AM, Terry Clemmer terry.clem...@imail.org wrote: Severe sepsis no, it depends on what organs are failing, septic shock yes. Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: terry.clem...@imail.org Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 12:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Dear Doris, Questions about strategies to improve practice on the listserv are a good thing. Not having a strategy beyond everyone's best judgment is probably not the right answer on the exam. I'm sure you have great judgment, but we all know many colleagues who would benefit from some guidance on where to place patients. Judgment alone hasn't done much to get adherence to best therapies. In the world's best example, Intermountain Healthcare in Utah, adherence to bundled therapies is 85% or so. Their mortality rate for severe sepsis is less than 10%. The rest of us can't say either of those things. Their publication is in peer review and soon we'll all see clearly the power of their example. I just wanted to survey the crowd that has demonstrated interest in this subject for what they do so I can fix my own problems. Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 -Original Message- From: Doberenz, Doris [doris.dober...@imperial.nhs.ukmailto:doris.dober...@imperial.nhs.uk] Sent: Sunday, March 17, 2013 08:44 AM Pacific Standard Time To: 'sepsisgroups@lists.sepsisgroups.org' Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong? Why is so much written about this without much real content? How many more or less rhetoric questions with or without answers because our patients and their diseases and severity actually vary... OOOPS who'd have thought that!? For example 'where severe sepsis belongs' will depend on seeing the patient as a clinician in addition to certain quite clear severity criteria in their context and conjunction e.g. heart rate, blood pressure, resp rate, urine output, lab signs of organ failure, lactate, central venous sats if available), and to decide how severe the whole situation is and thus how much monitoring and support a specific patient in a specific situation and severity needs. How many more mails and how many more pages of guidelines and time and expense of development of these guidelines by experts do we need for this and how many not always sufficiently evidence based but dictatorial bundles, which then get overtaken by the scientific evidence (e.g APC, steroids)??? Back t o the shopfloor (and the floor or the ICU according to the real need) and back to basics, and back to applying good medicine and good science for each individual patient and his or her specific situation rather than being spoonfed and dictated bundle criteria from some institute without sufficient robust and durable scientific evidence... Doris Doberenz FRCA FFICM EDAIC EDA Consultant Intensive Care Unit and Anaesthetic Department Charing Cross Hospital Fulham Palace Rd London W6 8RF Tel 020 3311 1234 bleep 5742 Mobile 07855 754 160 -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: 15 March 2013 06:32 To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Imperial College Healthcare NHS Trust notice: The contents of this e-mail are confidential to the ordinary user of the e-mail address to which it is addressed and may also be privileged. If you are not the addressee of this e-mail you may not copy, forward, disclose or otherwise use it in any form whatsoever. If you have received this e-mail in error please telephone the Imperial College Healthcare NHS Trust on +44 (0)20 3311 3311 and ask for the person who sent you the email. Please also delete the message from your computer. [end] ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Sean, Although I believe you know the answer that comes from Sutter Health - Sacramento Sierra Region from our data that you have seen, the answer to your question is, IMHO, fairly pragmatic. In our larger (community) hospitals, as many severe sepsis patients as possible go directly from ED to the ICU (2/3 - 3/4) and in those institutions our mortality rates are significantly improved. But our smaller hospitals, where the ICU bed capacity is 6-8, the majority of severe sepsis patients are admitted to med- surg with attendant higher mortality rates. (with one notable exception in Amador where a small hospital with an 6 bed ICU admits severe sepsis patients to the unit more frequently again with an attendant lower mortality rate) Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: dal...@sutterhealth.org Blackberry: 916.200.5604 Office: 916.614.6370 You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. R. Buckminster Fuller -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Thursday, March 14, 2013 11:32 PM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Why is so much written about this without much real content? How many more or less rhetoric questions with or without answers because our patients and their diseases and severity actually vary... OOOPS who'd have thought that!? For example 'where severe sepsis belongs' will depend on seeing the patient as a clinician in addition to certain quite clear severity criteria in their context and conjunction e.g. heart rate, blood pressure, resp rate, urine output, lab signs of organ failure, lactate, central venous sats if available), and to decide how severe the whole situation is and thus how much monitoring and support a specific patient in a specific situation and severity needs. How many more mails and how many more pages of guidelines and time and expense of development of these guidelines by experts do we need for this and how many not always sufficiently evidence based but dictatorial bundles, which then get overtaken by the scientific evidence (e.g APC, steroids)??? Back t o the shopfloor (and the floor or the ICU according to the real need) and back to basics, and back to applying good medicine and good science for each individual patient and his or her specific situation rather than being spoonfed and dictated bundle criteria from some institute without sufficient robust and durable scientific evidence... Doris Doberenz FRCA FFICM EDAIC EDA Consultant Intensive Care Unit and Anaesthetic Department Charing Cross Hospital Fulham Palace Rd London W6 8RF Tel 020 3311 1234 bleep 5742 Mobile 07855 754 160 -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: 15 March 2013 06:32 To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org Imperial College Healthcare NHS Trust notice: The contents of this e-mail are confidential to the ordinary user of the e-mail address to which it is addressed and may also be privileged. If you are not the addressee of this e-mail you may not copy, forward, disclose or otherwise use it in any form whatsoever. If you have received this e-mail in error please telephone the Imperial College Healthcare NHS Trust on +44 (0)20 3311 3311 and ask for the person who sent you the email. Please also delete the message from your computer. [end] ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Sean, At our institution and I am sure at other hospitals a number of septic patients are admitted to the floor and subsequently within 24hr are transferred to CC- sicker and likely with longer LOS than if they had been initial monitored and fluid resuscitated more closely in CC from the onset. CC units in best practice hospital according to the APACHE III data base have between 10 to 20 low risk monitor patients (i.e. are not actively receiving a CC dependent intervention) but are At-Risk this I believe is appropriate similar to negative lap rate for appendectomies so as to not miss any- as the down side is great. If your institution has an experience different than above then perhaps your may have too many low risk monitor patients in CC and could benefit from a change in strategy . Looking at our data however we are still admitting too many patents that would benefit from intensive monitoring to the floors with delay in resuscitation and its associated morbidity and mortality. Your question I believe is where is the break point when a CC admission is not need for a septic patient. In my opinion if you still meet sever sepsis criteria after initial ED or floor resuscitation (1000cc of fluids and antibiotics) you will likely benefit from CC. Moving a septic patient out of CC after 6 or 12hr, if no longer, needed makes more sense than transferring to CC after 6 or 12 hr of under resuscitation. My thoughts, Frank. Frank Sebat MD FCCM Medical Director of RRS Kaweah Delta Medical Center Visalia Sent: March 14, 2013 11:31 PM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Hello Dr. Townsend, The successful systematic approach to the determination of Severe Sepsis has no choice but the ICU. The death statistics used to propagate the protocols adoption have left no other choice but an all out attempt to prevent the patient's well researched impending death. That being the ICU as universal best place to try and prevent it. Saying you don't need the ICU to those who have yet to adopt a sepsis protocol is to say to them that they're not really in that great of danger. An awareness campaign is a double edged sword. Matt Reavill -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Hi Sean, Certainly in the UK, to take all patients with severe sepsis to ITU would swamp our services very quickly! We have relatively few ITU beds per capita and would adopt a more pragmatic approach, assessing first response to therapy and admitting those requiring haemodynamic and/or other organ support only. That said, we do have the luxury of Critical Care Outreach to keep an eye on such patients on the wards... BW Ron On Friday, March 15, 2013, Townsend, Sean, M.D. wrote: It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org javascript:; office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org javascript:; http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -- Dr Ron Daniels *Chair- UK Sepsis Trust* *Chief Executive- Global Sepsis Alliance Founding Fellow- Faculty of Intensive Care Medicine* *Suspect sepsis- save someone’s life today!* * Twitter: @Sepsis UK* ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Our answer to your question is no. Everyone who needs EGDT and agrees to treatment gets admitted to the ICU. If the patient gets adequate evaluation, treatment and stabilization in the emergency room, then a very large percentage of patients with severe sepsis can be treated outside of the ICU. Jeffrey Silvers, M.D. Medical Director of Quality Eden Medical Center Castro Valley, CA -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Thursday, March 14, 2013 11:32 PM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Severe sepsis no, it depends on what organs are failing, septic shock yes. Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: terry.clem...@imail.org Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq. -Original Message- From: sepsisgroups-boun...@lists.sepsisgroups.org [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 12:32 AM To: 'sepsisgroups@lists.sepsisgroups.org' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email towns...@sutterhealth.org office (415) 600-5770 fax (415) 600-1541 ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ___ Sepsisgroups mailing list Sepsisgroups@lists.sepsisgroups.org http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
