Please note a new e-mail address for me. Sound words, Ron!
BW Ron (D) On 2/7/13, Taylor, Barbara A <[email protected]> wrote: > In the data collection tool we utilized we asked if there was a working > diagnosis of Severe Sepsis or Septic shock at the time of admission for ED > Admit? Y/N > If No, then was Severe Sepsis or Septic shock a working diagnosis during > hospitalization? Y/N –Collecting this date and time. > Our hospital sepsis team was composed of ED, Infection Specialist and > Critical Care Intensivist – they would discuss the cases that seemed > questionable and determine what was the most appropriate course for patient. > There were times when it was thought no they are specific such as in the > patient with dementia who presents with slight change in MS (based upon > family input) or patients with chronic disease such as COPD or CHF. > Any cases that were placed on the Sepsis bundle orders in less than 24 hours > of ED admission were sent for ED Peer review to determine if there was a > miss or delay. In addition, in house cases that appeared to be a miss were > sent for review by the Infection Specialist on our team. > > From: Ron Elkin [mailto:[email protected]] > Sent: Wednesday, February 06, 2013 7:15 PM > To: Crittenden, Andrea L > Cc: Hunter, Patricia; Taylor, Barbara A; Ron Daniels; > [email protected] > Subject: Re: [Sepsis Groups] Time Zero > > I believe SSC defines Time Zero as "triage time" for ED patients and "time > of diagnosis" for patients elsewhere in the hospital. > In support of ED triage time, one would argue that it is a simple, easily > determined time in all hospitals and avoids the inevitable endless,debate > about the accuracy of time of diagnosis. The counter-argument has been that > this definition will not account for and will unduly penalize those > confronting patients with true delays in development of the syndrome after > arrival in ED. The clarity of triage time has prevailed as the standard. The > expectation is that both iatrogenic and true delays in diagnosis will haunt > us all and the closer we can push initiation of treatment to the > indisputable time of triage, the better the outcome expected at each > center. > > From a quality improvement perspective, however, it seems unreasonable to > expect caregivers to act appropriately before arriving at a working > diagnosis of severe sepsis or septic shock. For this reason, our center > chose to examine two questions, each with different implications for > improving performance: > 1) Did the working diagnosis trigger appropriate and timely therapy? If not, > specific protocol, personnel, and systems issues must be examined and > corrected. > 2) Was the working diagnosis timely,or was it delayed due to > nurse/physician/systems error? If delayed, distinctly different issues must > be examined. A delayed diagnosis may fall into 3 categories: > i) Potential delay - example: someone with SIRS and a potential > source of infection with delayed testing for later-documented organ > dysfunction. > ii) Real delay - example: organ dysfunction was timely documented > but not recognized as severe sepsis. > iii) Both i and ii. > . > I can't recall literature addressing this, but we estimate delay in > diagnosis in roughly 20% of our patients due to error. The analysis has > helped us better categorize and address our problems. > On a different note, it is well established that about 15% of patients with > severe sepsis or septic shock lack 2 or more signs of SIRS. These are > largely elderly and/or immunosuppressed patients. SIRS remains an important > screening tool, but when absent, severe sepsis must still be considered a > potential cause of unexplained organ dysfunction - in apparent contradiction > of consensus definitions. > My $0.02 > Ron Elkin MD > California Pacific Medical Center > San Francisco, CA > > > > > : > > > On Wed, Feb 6, 2013 at 12:34 PM, Crittenden, Andrea L > <[email protected]<mailto:[email protected]>> > wrote: > We use ICD-9 codes Severe Sepsis 995.92 or Septic Shock 785.52. > > Andrea Crittenden, RN > Quality Improvement Specialist > Providence St. Peter Hospital- Olympia, WA > 360-486-6465<tel:360-486-6465> > > From: > [email protected]<mailto:[email protected]> > [mailto:[email protected]<mailto:[email protected]>] > On Behalf Of Hunter, Patricia > Sent: Wednesday, February 06, 2013 9:33 AM > To: Taylor, Barbara A; Ron Daniels > Cc: > [email protected]<mailto:[email protected]> > > Subject: Re: [Sepsis Groups] Time Zero > > Our Hospital currently performs Sepsis audits on ED and IP. We are relying > on clinical personnel to capture sepsis patients for the audit. There is > much discussion about moving the audit to more retroactive and pulling those > patients with codes specific to Sepsis. Is anyone doing auditing relying on > coding solely? > If so, what ICD9 Codes are you using to pull data? > > Thanks, > Pat > > > Patricia Hunter, RN > Clinical Data Analyst > Performance Excellence > Mercy Medical Center - Des Moines, Iowa > 515-643-2206<tel:515-643-2206> > > "Life is not about waiting for the storms to pass... > it's about learning to dance in the rain!" > > > This electronic mail and any attached documents are intended solely for the > named addressee(s) and contain confidential information. If you are not an > addressee, or responsible for delivering this email to an addressee, you > have received this email in error and are notified that reading, copying, or > disclosing this email is prohibited. If you received this email in error, > immediately reply to the sender and delete the message completely from your > computer system. > > ________________________________ > This message is intended for the sole use of the addressee, and may contain > information that is privileged, confidential and exempt from disclosure > under applicable law. If you are not the addressee you are hereby notified > that you may not use, copy, disclose, or distribute to anyone the message or > any information contained in the message. If you have received this message > in error, please immediately advise the sender by reply email and delete > this message. > > _______________________________________________ > Sepsisgroups mailing list > [email protected]<mailto:[email protected]> > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > > This email was sent securely from the LGHealth Email Service > > Confidentiality Notice: > This e-mail message, including any attachments, is for the sole use > of intended recipient(s) and may contain confidential and > privileged information. > Any unauthorized review, use, disclosure or distribution is > prohibited. > If you are not the intended recipient, please contact the sender by > reply e-mail and destroy all copies of the original message. > (Notice #57A9E32F7BC) -- Dr Ron Daniels Chair- UK Sepsis Trust Chief Executive- Global Sepsis Alliance Founding Fellow- Faculty of Intensive Care Medicine Suspect sepsis- save someone’s life today! 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