Hi Dr Hess, I would certainly agree although appreciate there may be UK/US differences
I've been involved in conducting the College of Emergency Medicine Sepsis Audit for our ED this spring. Trying to identify the patients retrospectively through coding (either hospital or ED coding systems) failed to generate any meaningful data. In my opinion, given the current coding systems in use, prospective identification of these patients using a screening tool in the ED may be more reliable. This is then retained when the patient leaves the ED. These patients can then be audited. I'm aware that for this method patients will still slip though the net and the diagnosis may become more apparent once they have hit the ward but it does seem to be an improvement on just using coding. I think I remember someone mentioning on this list last year that they chase up all patients through the ED (possibly hospital) who had blood cultures or raised WCC's to try and ensure capture of as many patients as possible - more thorough but more time consuming I guess. Would be interested to hear what other departments do. Regards Dr Stuart Nuttall Consultant in Emergency Medicine Leeds Teaching Hospitals. On 12 Apr 2012, at 13:09, Hess, Dr. Donald wrote: > After reading a recent article in the April 4, 2012 issue of JAMA (Lindauer > PK, et al, Association of Diagnostic Coding With Trends in Hospitalizations > and Mortality of Patients With Pneumonia, 2003-2009 - > http://jama.ama-assn.org/content/307/13/1405.full), I decided to look at my > institution’s administrative data regarding the number of hospitalizations in > the past 4 years that were coded with the ICD9# for either sepsis or severe > sepsis as the primary diagnosis. There were none. Zero. I have long > suspected that one obstacle to diagnosing sepsis or severe sepsis is that > most physicians (and perhaps coders, too) regard it as a secondary diagnosis. > That sepsis is always secondary to something else…not a primary diagnosis > that represents a final common pathway due to a number of different causes. > There are likely a number of other cognitive factors related to the avoidance > of diagnosing sepsis and severe sepsis as a primary diagnosis. But evidently > physicians & coders at other institutions are doing it. I look forward to > your comments. > Regards, > > Dr. Don Hess > > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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