Thank you Joe for sending this out. As the Director for The Integrated Nurse Leadership Program (INLP) at UCSF where this table and methodology was created, developed and published, I can speak to this approach in a broad-based manner.
Should anyone like further knowledge about it origins, validated methods or real-world application, I’d be happy to discuss. Julie Kliger, MPA, BSN, RN Founder and Principal, The Altos Group, LLC www.thealtosgroup.com<http://www.thealtosgroup.com> Director, Integrated Nurse Leadership Program University of California at San Francisco 510.551.3330 (c) From: [email protected] [mailto:[email protected]] On Behalf Of Joseph Clement Sent: Thursday, December 06, 2012 8:31 AM To: [email protected] Subject: Re: [Sepsis Groups] mortality Hello All, I've received many requests to specify our code list so in the interest of efficiency I'll share it directly here. Again, patients in the denominator are those with either a sepsis code (Table 1: 995.91, 995.92, or 785.52) or both a code for infection (Table 2) and a code for an organ dysfunction (Table 2). We then review each case for inclusion/exclusion criteria and measure bundle compliance. Approximately 30% of cases do not have severe sepsis. We also add to this list other cases that are found in real-time (I review all rapid-response team calls, get referrals from nurses, hospitalists, pharmacists, and just snoop around). While we do occasionally find cases that were not coded as above, it is relatively rare. One of the reasons I like this method is that it is unlikely to be influenced by changes in coding and documentation. We are beginning a program to improve MD documentation (real-time feedback by documentation specialists) - and part of that is to encourage more accurate use of the terms severe sepsis, and septic shock which are generally underused, and therefore undercoded. If we measured mortality only with 995.92 and 785.52, then over time we would see a growing number of less acutely ill patients included in our denominator, thus artificially lowering our mortality rate. I'm enjoying this thread - this is a tricky issue that we've struggled with and I'm interested to learn the pros and cons of various methods. -Joe Table 1 – DESCRIPTION CODE Surviving Sepsis ICD-9-CM Codes Systemic Inflammatory Response Syndrome with Organ Dysfunction (Severe Sepsis) 995.91 995.92 Septic Shock 785.52 Table 2 – DESCRIPTION CODE Infection Related ICD-9-CM Codes Streptococcal Septicemia 038.00 Staphylococcal Septicemia 038.10-038.19 Pneumococcal Septicemia 038.20-038.29 Septicemia due to Anaerobes 038.30-038.39 Septicemia due to other Gram Negative Org. 038.40-038.49 Other Specified Septicemias 038.80-038.89 Unspecified Septicemia 038.90-038.99 Salmonella Septicemia 003.10-003.19 Septicemic Plague 020.20-020.29 Anthrax Septicemia 022.30-022.39 Meningococcemia 036.20-036.29 Waterhouse-Friderichsen Syndrome 036.30-036.39 Herpetic Septicemia 054.50-054.59 Candidiasis Disseminated 112.50-112.59 Pneumococcal Pneumonia 481.00-482.99 Bronchopneumonia, Organism Unspecified 485.00-486.99 UTI, Site not Specified 599.00-599.09 Acute Pyelonephritis 590.10-590.19 Other Pyelonephritis or Infection of Kidney 590.80-590.99 Table 3 – DESCRIPTION CODE Organ Dysfunction ICD-9-CM Codes Respiratory Acute Respiratory Failure518.81-518.82 Other Dyspnea/Respiratory Abnormalities786.09 Respiratory Arrest799.10 Cardiovascular Shock without Mention of Trauma785.50-785.59 Cardiac Arrest427.50 Hypotension458.00, 458.80, 458.90 Nonspecific Low Blood Pressure Reading796.30 Coagulation Defibrination Syndrome286.60 Other and Unspecified Coagulation Defect286.90 Renal Acute Renal Failure584.00-584.99 Hepatic Acute and Subacute Necrosis of Liver570.00-570.99 Hepatic Coma572.20 Hepatic Infarction573.40 Central Nervous System Delirium293.00-293.90 Anoxic Brain Damage348.10 Encephalopathy - Unspecified348.30 Coma780.0 Joseph Clement RN, MS, CCNS Clinical Nurse Specialist San Francisco General Hospital phone: (415) 206-6174 pager: (415) 327-0220 [email protected]<mailto:[email protected]> Joseph Clement <[email protected]<mailto:[email protected]>> Sent by: [email protected]<mailto:[email protected]> 12/04/2012 03:20 PM To > cc Subject Re: [Sepsis Groups] mortality Hello, We use a methodology used by many hospitals in the area, adapted from research by Viktor Dombrovskiy. It is based on ICD-9 codes only. There are no exclusion criteria. Patients in the denominator are those with either a sepsis code (995.91, 995.92, or 785.52) or both a code for infection (e.g. pneumonia) and a code for an organ dysfunction (e.g. acute renal failure). We have a specific list of codes we use if people are interested. Joe Joseph Clement RN, MS, CCNS Clinical Nurse Specialist San Francisco General Hospital phone: (415) 206-6174 pager: (415) 327-0220 [email protected]<mailto:[email protected]> "CARIANN M DAHLQUIST" <[email protected]<mailto:[email protected]>> Sent by: [email protected]<mailto:[email protected]> 11/28/2012 11:28 AM To <[email protected]<mailto:[email protected]>> cc 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 ------------------------------------------------------------------------------------------------------------------- CONFIDENTIAL & PRIVILEGED COMMUNICATION This email and any files transmitted with it are confidential, may contain privileged or copyright information, and are intended solely for the use of the intended recipient. If you are not the intended recipient of this email, you are required to notify the sender immediately and delete this email from your system. You may not copy, distribute or use this email or the information contained in it for any purpose other than to notify the sender. We do not guarantee that this material is free from viruses or any other defects although due care has been taken to minimize the risk. 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