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

[Rivers, Emanuel]

Very well said.


ER


​


From: Sepsisgroups <sepsisgroups-boun...@lists.sepsisgroups.org> on behalf of 
Ron Elkin <elkin@gmail.com>
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 
<twest54...@yahoo.com<mailto:twest54...@yahoo.com>> 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<mailto:sepsisgroups-requ...@lists.sepsisgroups.org>"
 
<sepsisgroups-requ...@lists.sepsisgroups.org<mailto:sepsisgroups-requ...@lists.sepsisgroups.org>>
To: 
sepsisgroups@lists.sepsisgroups.org<mailto: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"
<barne...@sutterhealth.org<mailto:barne...@sutterhealth.org>>
To: "Orth, Claudia" <cor...@mhc.net<mailto:cor...@mhc.net>>, jenny clarke 
<j...@live.com<mailto:j...@live.com>>,
"Tara Miller" 
<tara.mil...@infirmaryhealth.org<mailto:tara.mil...@infirmaryhealth.org>>
Cc: 
"sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>"

<sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: Re: [Sep

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

[Ron Elkin]

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" <
> 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
>
> Send Sepsisgroups mailing list submissions to
> sepsisgroups@lists.sepsisgroups.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-
> sepsisgroups.org
>
> or, via email, send a message with subject or body 'help' to
> sepsisgroups-requ...@lists.sepsisgroups.org
>
> You can reach the person managing the list at
> sepsisgroups-ow...@lists.sepsisgroups.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of Sepsisgroups digest..."
>
>
> 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:
>  namprd11.prod.outlook.com>
>
> Content-Type: text/plain; charset="utf-8"
>
> At Sutter Health we have several:
> First is ?possible sepsis? for Infection (active culture, problem list)
> plus available SIRS
> Second is ?possible severe sepsis? ? same as above plus available organ
> dysfunction (excludes BUN/Cr for example for ESRD)
> Third is ?possible septic shock?  - above with Lactate > 4
>
> 1 and 2 fire only for RNs 3 fires for RN, and providers
>
> We are moving toward predictive analytics(PA) ? and may or may not
> continue with BPAs ? or just go to PA alerts where the recipient doesn?t
> need to be in the chart to be notified, as with a BPA
>
> 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 <(916)%20200-5604>| barne...@sutterhealth.org barne...@sutterhealth.org>
>
> ?Do the best you can until you know better. Then when you know better, do
> better? Maya Angelou
> [https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_

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

[Thomas Westover]

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, FACOGAsst Professor MFM and ObgynCooper Medical School, 
Rowan University Vice Chair, NJ ACOGCo-Chair, NJ Hospital Association Statewide 
Perinatal Safety CollaborativeCamden 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
   
Send Sepsisgroups mailing list submissions to
    sepsisgroups@lists.sepsisgroups.org

To subscribe or unsubscribe via the World Wide Web, visit
    http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org

or, via email, send a message with subject or body 'help' to
    sepsisgroups-requ...@lists.sepsisgroups.org

You can reach the person managing the list at
    sepsisgroups-ow...@lists.sepsisgroups.org

When replying, please edit your Subject line so it is more specific
than "Re: Contents of Sepsisgroups digest..."


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:
    

    
Content-Type: text/plain; charset="utf-8"

At Sutter Health we have several:
First is ?possible sepsis? for Infection (active culture, problem list) plus 
available SIRS
Second is ?possible severe sepsis? ? same as above plus available organ 
dysfunction (excludes BUN/Cr for example for ESRD)
Third is ?possible septic shock?  - above with Lactate > 4

1 and 2 fire only for RNs 3 fires for RN, and providers

We are moving toward predictive analytics(PA) ? and may or may not continue 
with BPAs ? or just go to PA alerts where the recipient doesn?t need to be in 
the chart to be notified, as with a BPA

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
[https://newsplus.sutterhealth.org/peninsula-coastal/files/2017/04/SH_Pride_Plus400-002-177x177.gif]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Orth, Claudia
Sent: Wednesday, November 15, 2017 12:50 PM
To: jenny clarke ; Tara Miller 
Cc: sepsisgroups@lists.sepsisgroups.org
Subject: [**External**] Re: [Sepsis Groups] Sepsis Best Practice Alerts


WARNING: This email originated outside of the Sutter Health email system!
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Would you be able to share what criteria is used to fire the Best Practice 
Alert (BPA). We currently have 2 alerts that fire: 1 for SIRS and 1 for SIRS 
PLUS organ dysfunction. We are