Re: [Sepsis Groups] mortality

[Rivers, Emanuel]

Ms. Patricia Cormack,

This is music to my ears.

ER


From: sepsisgroups-boun...@lists.sepsisgroups.org 
[sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of Cormack, Patricia 
(WS) [pcorm...@westsubmc.com]
Sent: Wednesday, December 05, 2012 2:13 PM
To: John Brady; peggy.siene...@hcahealthcare.com; cdahlqu...@altru.org; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] mortality

John,
We resuscitate ESRD patients aggressively, but carefully, by using targets 
(CVP, SV). If the CXR is clear…bolus and treat the shock. Our renal service was 
nervous about aggressive resuscitation when we first implemented our sepsis 
program in 2007. They are now firm believers in resuscitating ESRD. It’s a 
shame to develop liver failure from under-resuscitation in a patient who 
already has renal failure- outcomes are very poor when this occurs. We’ve never 
had to intubated an ESRD patient for fluid overload. We tend to dialyze them in 
the first 24-48 hours once the shock is resolved.
Patty Cormack RN, MSN
Critical Care Clinical Educator
Sepsis Coordinator
CV Coordinator
Vanguard West Suburban Medical Center
P 708-763-6662
Pager 630-255-6049
pcorm...@westsubmc.commailto:pcorm...@westsubmc.com

From: sepsisgroups-boun...@lists.sepsisgroups.org 
[mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of John Brady
Sent: Tuesday, December 04, 2012 6:03 PM
To: peggy.siene...@hcahealthcare.com; cdahlqu...@altru.org; 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] mortality


When you have sepsis patients that have chronic renal failure how aggressive 
are you with volume resuscitation?


John Brady Quality Nurse Manager
St. Mary Medical Center
760 242 2311 ( 5369)

From: 
sepsisgroups-boun...@lists.sepsisgroups.orgmailto:sepsisgroups-boun...@lists.sepsisgroups.org
 [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
peggy.siene...@hcahealthcare.commailto:peggy.siene...@hcahealthcare.com
Sent: Monday, December 03, 2012 5:56 AM
To: cdahlqu...@altru.orgmailto:cdahlqu...@altru.org; 
sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] mortality

I count by discharge ICD9 code…so anyone with severe sepsis /or septic shock 
get counted for that month upon discharge…separate stats for each code.


Peggy Sienecki, RN
Sepsis Coordinator
Fawcett Memorial Hospital
Port Charlotte, FL


[cid:image001.jpg@01CDD2EA.14C816D0]


From: 
sepsisgroups-boun...@lists.sepsisgroups.orgmailto:sepsisgroups-boun...@lists.sepsisgroups.org
 [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of CARIANN M 
DAHLQUIST
Sent: Wednesday, November 28, 2012 2:29 PM
To: 
sepsisgroups@lists.sepsisgroups.orgmailto:sepsisgroups@lists.sepsisgroups.org
Subject: [Sepsis Groups] mortality

Hello fellow sepsis coordinators,
I am inquiring how everyone counts their sepsis mortality. I am curious if you 
count each patient chart or if you count by patient days? I currently only 
audit the critical care patients, however I am looking to expand to house wide. 
Any input would be appreciated-
Thanks,
CariAnn


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Re: [Sepsis Groups] [**External**] Sepsis Alert

[Rivers, Emanuel]

Count me in

Sent from my iPhone

On Jun 1, 2017, at 5:07 PM, elkin.ron 
> wrote:

Agree Dale. Regarding diagnosis, management, and prognosis the arrest patients 
are a much different cohort than the sepsis group at large and may benefit from 
a focused study.

Ron Elkin


 Original message 
From: "Brochis, Dale." >
Date: 6/1/17 11:59 (GMT-08:00)
To: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC" 
>, Ron Elkin 
>, "Townsend, Sean, M.D." 
>
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: RE: [Sepsis Groups] [**External**] Sepsis Alert

The interesting point I pulled from this thread is
“The study showed worse physiologic derangements and ED survival in arrest 
patients that were bacteremia, but survivals were not different at 28 days or 
beyond. I don't see a comparison of outcomes for bacteremia patients who 
received antibiotics in ED versus those that did not.”

How does that translate to treatment?  We can exclude patients in arrest so our 
data is clean. Because if they come in “dead” of course they will have worsened 
physiological derangements and survival.

OR we can include patients in arrest because aggressive TX will make a 
difference in those not past the point of no return.  “but survivals were not 
different at 28 days or beyond.”

Is anyone interested in capturing data on bacteremia post arrest survivor rates 
based on time of antibiotic administration?


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Barnes-Daly, Mary Ann, MS, RN, CCRN, DC
Sent: Tuesday, May 30, 2017 3:58 PM
To: Ron Elkin; Townsend, Sean, M.D.
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Great points Ron; I agree with your conclusion

Thanks,

MARY ANN BARNES-DALY MS RN CCRN DC  | Clinical Performance Improvement 
Consultant
Quality & Clinical Effectiveness Team | Office of Patient Experience
Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833
Mobile 916.200.5604| barne...@sutterhealth.org

“Do the best you can until you know better. Then when you know better, do 
better” Maya Angelou


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Ron Elkin
Sent: Friday, May 19, 2017 9:32 AM
To: Townsend, Sean, M.D. 
>
Cc: 
sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

The study showed worse physiologic derangements and ED survival in arrest 
patients that were bacteremic, but survivals were not different at 28 days or 
beyond. I don't see a comparison of outcomes for bacteremic patients who 
received antibiotics in ED versus those that did not.

The criteria for a diagnosis of severe sepsis or septic shock have included 
suspicion of infection (susceptible to the biases of the observer), SIRS (not 
sensitive or specific but quite likely in arrest both with or without sepsis), 
and evidence of acute organ dysfunction related to infection (but common in 
arrest with or without sepsis).

For the individual patient, a significant challenge would be to distinguish 
between arrest only, arrest with severe sepsis/septic shock, and arrest with 
coincidental bacteremia insufficient to cause severe sepsis/septic shock. Organ 
failure, lactate, and procalcitonin, the latter two sometimes elevated in 
severe physiologic stress of any kind, will not provide this distinction for 
the individual patient.

Therefore,one can make a good case for excluding these patients from analysis 
in the larger group of patients with severe sepsis/septic shock without arrest, 
or at least restricting the analysis to arrest patients.

Thanks for the discussion.

Ron Elkin
San Francisco

On Fri, May 19, 2017 at 7:19 AM, Townsend, Sean, M.D. 
> wrote:
The interesting thing is that the original proposal was to delete these 
patients from your data, but based on Ron’s sleuthing, they may actually be a 
real part of the data.  As a practical matter, it’s one of the last things docs 
will be thinking of in this situation.

Arguing for antibiotics in these cases at a minimum is not a bad idea.

Sounds like all providers will be affected equally with this problem, so I’m 
not worried from a data perspective, but interesting effort to provide 
education around antibiotics in post-arrest situations.

From: Cynthia Wells 
[mailto:cynthia.we...@steward.org]
Sent: Friday, May 19, 2017 7:04 AM
To: Ron 

Re: [Sepsis Groups] Sepsisgroups Digest, Vol 270, Issue 1

[Rivers, Emanuel]

Very well said.


ER


​


From: Sepsisgroups  on behalf of 
Ron Elkin 
Sent: Wednesday, November 29, 2017 11:10 PM
To: Thomas Westover
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 270, Issue 1

Dr. Westover -

AMEN

Isn't it a physician's job to know about changes in vital signs, mental status, 
or organ function? There is something seriously wrong with some of these 
people. They deserve early diagnosis and treatment whether it's sepsis or not. 
If we welcome rather than resist reporting, we'll miss fewer of these 
opportunities.

Ron Elkin, MD
Pulmonary/Critical Care
California Pacific Medical Center
San Francisco





On Mon, Nov 27, 2017 at 5:33 PM, Thomas Westover 
> wrote:
I find it interesting (and somewhat misguided) that people are trying to reduce 
the frequency of "false alarm" alerts... (acknowledging that alarm fatigue is a 
real entity!!!)

The whole point of a sepsis (or any) screening tool is to have a HIGH 
sensitivity (ie NOT miss true cases) at the expense of firing off false alarms 
(ie low specificity)

You dont want to reduce alerts.. you dont want to use "predictive analytics" to 
hone down who is affected vs who is false alarm... that is NOT the goal of the 
initial screening tool

You want the screening tool to be highly sensitive (ie "never" miss a true 
sepsis case); a positive screen will then aim the focus of the clinical 
team/physicians etc to more carefully evaluate the pt for progressive sepsis. 
So its the subsequent evaluation AFTER a positive screen that hones down who is 
true positive vs who is false positive

You can easily make the screening tool more specific (ie fewer false alarms) by 
creating a screening tool that will only pick up pts that are about to die from 
sepsis (altered mental status, grossly abnl vitals, severe shock, etc) but then 
the screening tool is ineffective at its intended goal; which is to alert the 
clinical team that the pt is starting to deteriorate NOT that the pt is about 
to arrest

the surviving sepsis campaign has struggled with these concepts for years 
(trying to balance sensitivity vs specificity); It's not their fault, its the 
nature of the beast of screening tools

Respectfully

Thomas Westover MD, FACOG
Asst Professor MFM and Obgyn
Cooper Medical School, Rowan University
Vice Chair, NJ ACOG
Co-Chair, NJ Hospital Association Statewide Perinatal Safety Collaborative
Camden NJ



From: 
"sepsisgroups-requ...@lists.sepsisgroups.org"
 
>
To: 
sepsisgroups@lists.sepsisgroups.org
Sent: Monday, November 27, 2017 12:49 PM
Subject: Sepsisgroups Digest, Vol 270, Issue 1

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Today's Topics:

  1. Re: [**External**] Re: Sepsis Best Practice Alerts
  (Barnes-Daly, Mary Ann, MS, RN, CCRN, DC)


--

Message: 1
Date: Fri, 17 Nov 2017 16:10:42 +
From: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC"
>
To: "Orth, Claudia" >, jenny clarke 
>,
"Tara Miller" 
>
Cc: 
"sepsisgroups@lists.sepsisgroups.org"

>
Subject: Re: [Sepsis Groups] [**External**] Re: Sepsis Best Practice
Alerts
Message-ID: