I agree with Mary Ann.
This works for our hospital. Our step down unit does not use SG
catheters or have the option of Prisma if needed. Previously, when we had the
option of treating our patients in two units (dependent upon physician decision
to place these patients) it appeared that we were transferring patients to the
ICU at critical times.
Obviously, we look at these cases and determined how best to
accommodate these patients. For our hospital, pts with severe sepsis are sent
to the ICU and TNU for ICU overflow times only. The patients are managed by
Critical Care physicians (Pulmonary Specialists) along with the Infection
Control Specialist. The patients hospitalist will have care of the patient
transferred over to them once the patient is ready for transfer out of the unit
setting.
Good day, Barb
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Daly, Mary Ann
Sent: Monday, March 18, 2013 12:19 PM
To: '[email protected]'; Townsend, Sean, M.D.;
'[email protected]'
Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Since I have gotten some feedback regarding my post about our admission to ICU
ratio to mortality I wanted to clarify.
I wasn't suggesting that every patient in every hospital with severe sepsis
requires an ICU admission. Just stating how our data supports this for our
institutions (6 in all)
Perhaps if we had more optimal care in other areas of the hospital the
necessity would be less for ICU
That said, I am reading many posts about 'good clinical medicine' and deciding
the disposition of the patient on a case-by-case basis. This is akin to how we
treated cardiac patients (and in some cases still do) i.e. deciding the
extent of cardiac involvement based on 'how the patient looks'. The problem
with placing patients who has responded to initial therapy on the floors - is
the level of surveillance and the rapid response to timely assessments = all
done more effectively in the ICU setting.
I would rather admit a stable patient to ICU for 6-12 hours then transfer
knowing that stability has been maintained then wait for a patient to
decompensate on the floors (data shows patients are typically in organ failure
for 12 hrs to 2-3 days before they are transferred) which confers an increased
mortality risk. This is supported by the SSC data base for the US and Europe.
Thanks,
Mary Ann Daly, RN BSN CCRN DC
Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and
Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region
E-mail: [email protected]
Blackberry: 916.200.5604 Office: 916.614.6370 You never change things by
fighting the existing reality. To change something, build a new model that
makes the existing model obsolete. R. Buckminster Fuller
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
[email protected]
Sent: Friday, March 15, 2013 9:05 AM
To: Townsend, Sean, M.D.; [email protected]
Subject: Re: [Sepsis Groups] Where Does Severe Sepsis Belong?
Sean,
My answer is NO...they do not all need ICU. I think it is very patient
specific and determined by "how close to the edge" they are....for lack of a
better way to say it right now. The numbers do not ALWAYS reflect the patient
status....We put some on the medical unit that seem to be stable after ED
treatment....sure, a tiny few may end up being RRT'ed later...but for the most
part....those with SS that are admitted to the floor instead of ICU seem to be
OK once they get the antibiotic and fluids in ED and stabilize rather quickly.
I would never treat it as a black and white decision with strictly numbers and
test results. One has to see the patient and know the patient...including
co-morbidities and response to the treatment you have initiated already. Just
my 2 cents.
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Townsend,
Sean, M.D.
Sent: Friday, March 15, 2013 2:32 AM
To: '[email protected]'
Subject: [Sepsis Groups] Where Does Severe Sepsis Belong?
It's been a long time since I've had to ask this question. I used to think I
knew the answer.
Here it is: do all patients who meet severe sepsis criteria need to be admitted
to the ICU ?
Examples:
1. Pneumonia, fever, tachycardia, INR 1.5.
2. Cellulitis, leukocytosis, fever, creatinine 2.0.
3. UTI, leukocytosis, fever, lactate 3.0.
Where do people put these patients in reality? What mind of monitoring do they
deserve?
By prevailing bundles, each gets lactate checked, blood cultures, broad
spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need
the ICU? Why?
Sean
Sean R. Townsend, M.D.
Vice President of Quality & Safety
California Pacific Medical Center
2330 Clay Street, #301
San Francisco, CA 94115
email [email protected]
office (415) 600-5770
fax (415) 600-1541
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