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 
<elkin@gmail.com<mailto:elkin@gmail.com>> 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." <dale.broc...@rwjbh.org<mailto:dale.broc...@rwjbh.org>>
Date: 6/1/17 11:59 (GMT-08:00)
To: "Barnes-Daly, Mary Ann, MS, RN, CCRN, DC" 
<barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>>, Ron Elkin 
<elkin@gmail.com<mailto:elkin@gmail.com>>, "Townsend, Sean, M.D." 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto: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<mailto: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<mailto: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. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto: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. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>> 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 sit

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

[Barnes-Daly, Mary Ann, MS, RN, CCRN, DC]

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. <towns...@sutterhealth.org>
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. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>> 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<mailto:cynthia.we...@steward.org>]
Sent: Friday, May 19, 2017 7:04 AM
To: Ron Elkin <elkin@gmail.com<mailto:elkin@gmail.com>>; Townsend, 
Sean, M.D. <towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: RE: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I definitely agree.. In order to meet the sepsis bundle we would still need the 
other two criteria- suspicion of infection/SIRS, hence we should start abx 
earlier to if nothing else prevent progression if arrest not related to 
bacteremia.  I am concerned about the fluids because most of these lactates are 
sky high they are automatically pulled into shock elements.

Cindy

Cynthia Wells
Steward Health Care
Director of Clinical Performance Analytics
(508) 404-8647<tel:(508)%20404-8647>

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Ron Elkin
Sent: Thursday, May 18, 2017 10:43 PM
To: Townsend, Sean, M.D. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Attached is a study showing a 38% incidence of bacteremia in ED patients 
presenting with out of hospital cardiac arrest. It is often unclear if the 
bacteremia was a contributing cause, or a result of the arrest, but the study 
suggests we should have a low threshold for instituting immediate empirical 
antimicrobial therapy in these patients.

Such patients will certainly complicate diagnosis, treatment, and outcomes if 
included in analysis of severe sepsis or septic shock unassociated with arrest.

Ron Elkin MD
San Francisco



On Wed, May 17, 2017 at 10:56 AM, Townsend, Sean, M.D. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org>> wrote:
I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 

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

[Ron Elkin]

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. <
towns...@sutterhealth.org> 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 Elkin <elkin@gmail.com>; Townsend, Sean, M.D. <
> towns...@sutterhealth.org>
> *Cc:* sepsisgroups@lists.sepsisgroups.org
> *Subject:* RE: [Sepsis Groups] [**External**] Sepsis Alert
>
>
>
> Hello,
>
> I definitely agree.. In order to meet the sepsis bundle we would still
> need the other two criteria- suspicion of infection/SIRS, hence we should
> start abx earlier to if nothing else prevent progression if arrest not
> related to bacteremia.  I am concerned about the fluids because most of
> these lactates are sky high they are automatically pulled into shock
> elements.
>
>
>
> Cindy
>
>
>
> Cynthia Wells
>
> Steward Health Care
>
> Director of Clinical Performance Analytics
>
> (508) 404-8647
>
>
>
> *From:* Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org
> <sepsisgroups-boun...@lists.sepsisgroups.org>] *On Behalf Of *Ron Elkin
> *Sent:* Thursday, May 18, 2017 10:43 PM
> *To:* Townsend, Sean, M.D. <towns...@sutterhealth.org>
> *Cc:* sepsisgroups@lists.sepsisgroups.org
> *Subject:* Re: [Sepsis Groups] [**External**] Sepsis Alert
>
>
>
> Attached is a study showing a 38% incidence of bacteremia in ED patients
> presenting with out of hospital cardiac arrest. It is often unclear if the
> bacteremia was a contributing cause, or a result of the arrest, but the
> study suggests we should have a low threshold for instituting immediate
> empirical antimicrobial therapy in these patients.
>
>
>
> Such patients will certainly complicate diagnosis, treatment, and outcomes
> if included in analysis of severe sepsis or septic shock unassociated with
> arrest.
>
>
>
> Ron Elkin MD
>
> San Francisco
>
>
>
>
>
>
>
> On Wed, May 17, 2017 at 10:56 AM, Townsend, Sean, M.D. <
> towns...@sutterhealth.org> wrote:
>
> I would agree this is a confounder. You could delete from your local focus
> study, but they will still hit the metric for purposes of SEP-1.  I'm not
> sure how often you see this to justify a change to SEP-1, but if common I'd
> take a look.
>
>
> On May 17, 2017, at 10:52 AM, Mary Draper <mary.dra...@johnmuirhealth.com>
> wrote:
>
> Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines
> with regards to patient who present in cardiac arrest to the ED. I have not
> found any information specific to this issue.  Most of them have an
> elevated lactate. It is difficult to determine what was the cause of the
> arrest.  We are proposing to our Sepsis committee that we delete these
> patients from the focus study.
> What are your thoughts on this subject?
> Thanks
>
> Mary Draper R

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

[Mary Draper]

Thanks Ron good analysis.

Mary Draper RN BSN
QI Coordinator
Quality Management
Office (925) 674-2045<tel:(925)%20674-2045>
Cell (925) 451-8792<tel:(925)%20451-8792>
Fax (925) 674-2373<tel:(925)%20674-2373>
mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com>

On May 18, 2017, at 7:42 PM, Ron Elkin 
<elkin@gmail.com<mailto:elkin@gmail.com>> wrote:

Attached is a study showing a 38% incidence of bacteremia in ED patients 
presenting with out of hospital cardiac arrest. It is often unclear if the 
bacteremia was a contributing cause, or a result of the arrest, but the study 
suggests we should have a low threshold for instituting immediate empirical 
antimicrobial therapy in these patients.

Such patients will certainly complicate diagnosis, treatment, and outcomes if 
included in analysis of severe sepsis or septic shock unassociated with arrest.

Ron Elkin MD
San Francisco



On Wed, May 17, 2017 at 10:56 AM, Townsend, Sean, M.D. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>>
 wrote:
I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 AM, Mary Draper 
<mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com><mailto:mary.dra...@johnmuirhealth.com>>
 wrote:

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045<tel:%28925%29%20674-2045>
Cell (925) 451-8792<tel:%28925%29%20451-8792>
Fax (925) 674-2373<tel:%28925%29%20674-2373>
mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com><mailto:mary.dra...@johnmuirhealth.com>

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
For then we will always strive for greater things and will not be content  with 
merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups 
[mailto:sepsisgroups-boun...@lists.sepsisgroups.org<mailto:sepsisgroups-boun...@lists.sepsisgroups.org>]
 On Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. 
<towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>>;
 Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org>>
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org><mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups 
[sepsisgroups-boun...@lists.sepsisgroups.org<mailto:sepsisgroups-boun...@lists.sepsisgroups.org><mailto:sepsisgroups-boun...@lists.sepsisgroups.org>]
 On Behalf Of Townsend, Sean, M.D. 
[towns...@sutterhealth.org<mailto:towns...@sutterhealth.org><mailto:towns...@sutterhealth.org>]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: 
sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org><mailto:sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org><mailto:erin.par...@ascension.org<mailto:erin.par...@ascension.org>>>
 wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, a

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

[Maggie.Macias]

I have had this occur as well. 

Maggie Macias, RN
Sepsis Program Coordinator
Valley Regional Medical Center
Brownsville, TX 
(956) 350-7179 (O)
maggie.mac...@hcahealthcare.com 


-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Townsend, Sean, M.D.
Sent: Wednesday, May 17, 2017 12:57 PM
To: Mary Draper <mary.dra...@johnmuirhealth.com>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: [EXTERNAL] Re: [Sepsis Groups] [**External**] Sepsis Alert

I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 AM, Mary Draper <mary.dra...@johnmuirhealth.com> 
wrote:

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks 

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
 For then we will always strive for greater things and will not be content  
with merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. <towns...@sutterhealth.org>; Parker, Erin 
<erin.par...@ascension.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
Townsend, Sean, M.D. [towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org>> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2FAscension.org%2FMichigan=02%7C01%7CTownseSR%40sutterhealth.org%7Cbcf81d122f5642b45bbc08d49d4d8358%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636306403617734269=mQq8Hjhaxl37u5wE%2FqOAyhW6JSn%2BvqAyXvPktgLYRnE%3D=0>
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org<mailto:erin.par...@ascension.org>


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

[Townsend, Sean, M.D.]

I would agree this is a confounder. You could delete from your local focus 
study, but they will still hit the metric for purposes of SEP-1.  I'm not sure 
how often you see this to justify a change to SEP-1, but if common I'd take a 
look.

On May 17, 2017, at 10:52 AM, Mary Draper <mary.dra...@johnmuirhealth.com> 
wrote:

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks 

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
 For then we will always strive for greater things and will not be content  
with merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. <towns...@sutterhealth.org>; Parker, Erin 
<erin.par...@ascension.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
Townsend, Sean, M.D. [towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org>> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2FAscension.org%2FMichigan=02%7C01%7CTownseSR%40sutterhealth.org%7Cbcf81d122f5642b45bbc08d49d4d8358%7Caef453eadaa243e0be62818066e9ff63%7C0%7C0%7C636306403617734269=mQq8Hjhaxl37u5wE%2FqOAyhW6JSn%2BvqAyXvPktgLYRnE%3D=0>
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org<mailto:erin.par...@ascension.org>


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

[Mary Draper]

Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with 
regards to patient who present in cardiac arrest to the ED. I have not found 
any information specific to this issue.  Most of them have an elevated lactate. 
It is difficult to determine what was the cause of the arrest.  We are 
proposing to our Sepsis committee that we delete these patients from the focus 
study.
What are your thoughts on this subject?
Thanks 

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management JMH
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com

"O, let us always have a mountain within our soul,  with a peak so high that we 
never quite reach the top...
  For then we will always strive for greater things and will not be content  
with merely climbing hills." Ardath Rodale

-Original Message-
From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Gwen S. Schneider
Sent: Saturday, May 13, 2017 10:20 AM
To: Townsend, Sean, M.D. <towns...@sutterhealth.org>; Parker, Erin 
<erin.par...@ascension.org>
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
Townsend, Sean, M.D. [towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org>> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan<http://Ascension.org/Michigan>
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org<mailto:erin.par...@ascension.org>


CONFIDENTIALITY NOTICE:

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

[Gwen S. Schneider]

Hello,
I am interested in the responses you might receive from your question. We use 
EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am 
wondering if other hospitals are doing the same. And what does MS have to say 
about it?

Sierra Schneider
Salem Oregon

From: Sepsisgroups [sepsisgroups-boun...@lists.sepsisgroups.org] On Behalf Of 
Townsend, Sean, M.D. [towns...@sutterhealth.org]
Sent: Thursday, May 11, 2017 9:36 PM
To: Parker, Erin
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: Re: [Sepsis Groups] [**External**]  Sepsis Alert

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
<erin.par...@ascension.org<mailto:erin.par...@ascension.org>> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan<http://Ascension.org/Michigan>
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org<mailto:erin.par...@ascension.org>


CONFIDENTIALITY NOTICE:

This email message and any accompanying data or files is confidential and may 
contain privileged information intended only for the named recipient(s). If you 
are not the intended recipient(s), you are hereby notified that the 
dissemination, distribution, and or copying of this message is strictly 
prohibited. If you receive this message in error, or are not the named 
recipient(s), please notify the sender at the email address above, delete this 
email from your computer, and destroy any copies in any form immediately. 
Receipt by anyone other than the named recipient(s) is not a waiver of any 
attorney-client, work product, or other applicable privilege.

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are hereby notified that any dissemination, distribution, or copying of this 
email is
strictly prohibited. If you have received this email in error, please notify the
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should
not retain, copy, or use this email or any attachment for any purpose; nor 
disclose
all or any part of the contents to any other person.
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Re: [Sepsis Groups] [**External**] Sepsis Alert

[Townsend, Sean, M.D.]

Erin,

I'm sorry you received an inflammatory and obtuse response to your question.  
Such posts have earned the name "troll" or having been "trolled" for  for a 
reason.

Maybe to get a real answer to your question, you could share with us which EHR 
you use?

Sean



On May 5, 2017, at 7:05 AM, Parker, Erin 
> wrote:


WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or 
Password.




Would any one like to share EHR sepsis alert criteria, and also be willing to 
share how it is working?
Thanks,
Erin

Erin Parker RN, BSN, ACM
Infection Preventionist, Epidemiology
Ascension  |  Genesys
One Genesys Parkway
Grand Blanc, MI 48439
Ascension.org/Michigan
T: 810.606.5093
F: 810-606-5495
M: erin.par...@ascension.org


CONFIDENTIALITY NOTICE:

This email message and any accompanying data or files is confidential and may 
contain privileged information intended only for the named recipient(s). If you 
are not the intended recipient(s), you are hereby notified that the 
dissemination, distribution, and or copying of this message is strictly 
prohibited. If you receive this message in error, or are not the named 
recipient(s), please notify the sender at the email address above, delete this 
email from your computer, and destroy any copies in any form immediately. 
Receipt by anyone other than the named recipient(s) is not a waiver of any 
attorney-client, work product, or other applicable privilege.

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