Morning,
The discussion has been very interesting. I agree with the latter comments that waiting for a patient to progress into severe sepsis/shock prior to initiating 'time zero' means you will loose a precious opportunity to prevent this cascade into organ dysfunction and failure. Our sepsis management is based on 2+SIRS with a 'suspicion' of an infective source. This certainly means that we overtreat with the initial Sepsis 6 interventions but with the intention that this will prevent the progression into severe sepsis, whilst 'doing no harm'. Time zero for us is time at first sepsis identification - which is not necessarily triage time, but often is. We have not concentrated on triage time alone because this is the organisational standard, and we expect anyone who identifies sepsis to initiate the call for help and Sepsis 6 implementation. Heather McClelland Nurse Consultant - Emergency Care Calderdale & Huddersfield NHS Foundation Trust Tel: 07766905556 From: [email protected] [mailto:[email protected]] On Behalf Of Terry Clemmer Sent: 08 February 2013 18:05 To: [email protected]; [email protected]; [email protected]; [email protected] Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected] Subject: Re: [Sepsis Groups] Time Zero That means they only want to pick up patients very late in their course of sepsis. The real opportunity is to identify patients early and prevent them from every going into septic shock. The latter is a much better way to improve the outcome in severe sepsis and septic shock. Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: [email protected] <mailto:[email protected]> "Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq." From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, February 07, 2013 5:02 PM To: [email protected]; [email protected]; [email protected] Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected] Subject: Re: [Sepsis Groups] Time Zero Our ED Physicians are wanting to call "time zero" the time of the first BP with systolic below 90. I have not found any research to support this approach. Any information I can share with them to bring them along would be welcome. (in particular research that looks at the issue) Thanks From: [email protected] [mailto:[email protected]] On Behalf Of Jeffrey R Hanlon RN Sent: Wednesday, February 06, 2013 6:58 PM To: [email protected]; [email protected] Cc: [email protected]; [email protected]; [email protected]; [email protected] Subject: Re: [Sepsis Groups] Time Zero Our time zero starts when the patient declares. If the SIRS criteria are met at triage then that is time zero. Should the patient for example have just tachycardia noted in triage and the WBC count comes back elevated that is time zero. Jeffrey R Hanlon RN Stamp Out Sepsis -----Original Message----- From: Ron Daniels <[email protected]> To: Karin Molander <[email protected]> Cc: Jacqui.Jones <[email protected]>; f.gaosmith <[email protected]>; sepsisgroups <[email protected]>; isabel.gonzalez <[email protected]> Sent: Wed, Feb 6, 2013 3:18 pm Subject: Re: [Sepsis Groups] Time Zero Thanks Karin, I understand the pragmatic reasons behind it, but personally I'm uncomfortable with using ICU admission time unless you can be certain there are never any delays in recognition, referral and ICU admission for ward-based patients. In the UK, this is far from the case and I would urge organizations not to measure only the performance of their ED and ITU (if there is no reliable temporal relationship between ward-based onset and ICU admission, this will ultimately have the effect of demonstrating non-efficacy of EGDT anyway). Kind regards Ron On Tue, Feb 5, 2013 at 3:58 PM, Karin Molander <[email protected]> wrote: We use Triage Time in ED for Sutter system. For those cases of sepsis caught on the wards, we use time of arrival to the ICU for time zero for start of EGDT bundle. Karin Molander MD FACEP Mills Peninsula Hospital Sutter On Tue, Feb 5, 2013 at 2:10 AM, Heather McClelland <[email protected]> wrote: Happy to be involved. Heather -------------------------- Sent from my BlackBerry Wireless Device ----- Original Message ----- From: Ron Daniels [mailto:[email protected]] Sent: Friday, February 01, 2013 10:08 PM To: Jones Jacqui (RTR) South Tees NHS Trust <[email protected]> Cc: Gonzalez Isabel (SOUTH TEES HOSPITALS NHS FOUNDATION TRUST) <[email protected]>; Fang Gao Smith <[email protected]>; <[email protected]> <[email protected]> Subject: Re: [Sepsis Groups] Time Zero Fang, this sounds like an opportunity for a global sampling of volunteer organizations. Ron Dr Ron Daniels Chair: UK Sepsis Trust CEO: Global Sepsis Alliance Sent on the move from my iPhone, excuse brevity! On 1 Feb 2013, at 13:40, "Jones Jacqui (RTR) South Tees NHS Trust" <[email protected]> wrote: > Hi Dr Fang Gao > > I would be very interested in participating in your next prospective > cohort study on behalf of South Tees NHS Trust. I currently collect data > on around 35 of our patients with severe sepsis each month. I look at > the time to each element of the sepsis six from time zero alongside > factors which influence the standards of care delivery. > > > > Regards > > Jacqui > > Jacqui Jones > Sepsis Specialist Nurse > South Tees Hospitals NHS Foundation Trust > 01642 850850 ext 56969 bleep 1008 > email [email protected] > > Suspect Sepsis: save someone's life today. > > > Sign our e-petition at http://epetitions.direct.gov.uk/petitions/19602 > > > > > -----Original Message----- > From: [email protected] > [mailto:[email protected]] On Behalf Of Fang > Gao Smith > Sent: 31 January 2013 21:01 > To: Jessica Harkey; [email protected] > Cc: Melody Teresa > Subject: Re: [Sepsis Groups] Time Zero > > Dear Jessica > We did a prospective cohort study on determining 'time zero' of severe > sepsis amongst critical care team 3-4 years ago with very interesting > results. Teresa, our dept manage should be able to feed you with more > information. Your suggestion has prompted us to consider to repeat this > study after 3-4 years sepsis education. Would you be interested to > participate? > > Best wishes > Fang > > > Fang Gao > Professor in Anaesthesia, Critical Care and Pain > Perioperative, Critical Care and Trauma Trials Group > School of Clinical and Experimental Medicine > University of Birmingham > > Academic Department of Anaesthesia, Critical Care, Pain and > Resuscitation > MIDRU Building > Birmingham Heartlands Hospital > Heart of England NHS Foundation Trust > > > [email protected]; [email protected]<mailto:[email protected]>; > 07711823212 > > Patricia Mponela: 0121 3713243; > [email protected]<mailto:[email protected]> > > Dawn Hill: 0121 424 2966; > [email protected]<mailto:[email protected]> > > > > From: Jessica Harkey <[email protected]<mailto:[email protected]>> > Date: Thu, 31 Jan 2013 17:10:03 +0000 > To: > "[email protected]<mailto:[email protected] > ups.org>" > <[email protected]<mailto:[email protected] > ups.org>> > Subject: [Sepsis Groups] Time Zero > > Hello, all- > We had some very good discussion at our last team meeting about defining > "time zero" for the bundle. Currently for the ED we use triage time. > Would anyone be willing to share what you use as time zero to begin > implementation of the bundle? > Thank you, > > > Jessica Harkey, RN, BSN, CCRN > Sepsis Program Coordinator > San Joaquin Community Hospital > 2615 Chester Avenue > Bakersfield, CA 93303 > 661-869-6874 > [email protected]<mailto:[email protected]> > > [cid:MBFOHERTDJDT.IMAGE_5.BMP] > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -- Dr Ron Daniels CEO: Global Sepsis Alliance Chair: United Kingdom Sepsis Group Principal Trustee: U.K Sepsis Trust Founding Director: Survive Sepsis Fellow: NHS Improvement Faculty Suspect Sepsis: save someone's life today. Join us for World Sepsis Day on September 13th <http://www.globalsepsisalliance.org/> Twitter: @sepsisuk _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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