Here are a couple of references that talk about using serial lactate to guide therapy.
Jansen TC, van Bommel J, Schoonderbeek FJ et al (2010) Early lactate-guided therapy in intensive care unit patients: a multicenter, openlabel, randomized controlled trial. Am J Respir Crit Care Med 182:752-761 Jones AE, Shapiro NI, Trzeciak S, Emergency MEDICINE SHOCK RESEARCH NETWORk (EMShockNet) Investigators et al (2010) Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 303:739-746 Hope this is helpful. Margaret Margaret M. Parker, MD, FCCM Professor of Pediatrics, Medicine, and Anesthesia Director of Pediatric Critical Care Medicine Stony Brook University Stony Brook, NY 11794-8111 Phone: (631) 444-2725 Fax: (631) 444-2894 [email protected]<mailto:[email protected]> From: [email protected] [mailto:[email protected]] On Behalf Of John Brady Sent: Tuesday, August 06, 2013 11:28 AM To: Pitkofsky, Charles; Bianca Chung; [email protected] Subject: Re: [Sepsis Groups] Cost Savings from Early Detection & Better Management of Sepsis We are having challenges with our inpatient physicians ordering lactate levels. We seem to be able to attain an order for the first lactate but they are reluctant to do serial lactate levels. I have a recent article from Emergency Medicine that talks about lactate as a predictor for mortality. Does anyone have an article that they feel gives a clear picture of how important lactate levels are. John Brady RN,BSN,CCRN,CNRN Quality Nurse Manager St. Mary Medical Center 760 242 2311 ( 5369) From: [email protected] [mailto:[email protected]] On Behalf Of Pitkofsky, Charles Sent: Monday, August 05, 2013 12:49 PM To: Bianca Chung; [email protected] Subject: Re: [Sepsis Groups] Cost Savings from Early Detection & Better Management of Sepsis We have been tracking lives saved a cost saved as part of our outcomes reporting for a grant. Here is the formula that we have been using" BMR = baseline mortality rate for combined severe sepsis and septic shock. We are using 2008 for our baseline mortality rate. BALOS = baseline average length of stay for combined severe sepsis and septic shock patients (this is the sum of all patient LOS/total # patients) - we are using 2008 for BALOS If you are looking at lives saved for 2013 Q1: Lives saved = (total number of severe sepsis/septic shock patients for 2013 Q1 x BMR) - actual # expired severe sepsis/septic shock patients for 2013 Q1 For cost saved, calculate patient days saved first: Patient days saved = (total number of severe sepsis/septic shock patients for 2013 Q1 x BALOS) - the sum of patient LOS days for 2013 Q1 Cost saved = Patient days saved x direct hospital costs per day Hope this helps, Chuck Charles Pitkofsky, RN, MSN Quality Manager Department of Quality Management Mills-Peninsula Health Services 1501 Trousdale Drive Burlingame, CA 94010-4506 Phone: 650.696.7880 Cell: 650.605.7684 "If you always do what you always did, you will always get what you always got." - Albert Eintstein [MPHS_Email_Color] Confidentiality Notice: This transmission and any attached documents may be confidential and contain information protected by State and Federal Medical Privacy statutes and is legally privileged. They are intended for use only by the addressee. If you are not the intended recipient of this transmission, or an agent of the intended recipient, you are prohibited from reading, disclosing, printing, saving, copying or using or otherwise disseminating any information contained in this transmission. If you received this transmission in error, please accept my apology and notify the sender via reply email. Please delete the entire message and its attachments. Thank you From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Bianca Chung Sent: Monday, July 29, 2013 1:44 PM To: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Cost Savings from Early Detection & Better Management of Sepsis Importance: High Hello, Has anyone in the group been tracking direct hard cost savings as a result of implementing a sepsis quality initiative? If you have had success, what costs could you tie to the sepsis program (e.g. cost of supplies, nurse overtime reduction, ICU bed/ day, etc.)? We are putting a ROI business case to executive management showing that implementing a sepsis program will result in hard dollar benefits. Thank you in advance for your advice. In the spirit of sharing, it is much appreciated. Sincerely, Bianca Chung ________________________________ Notice from St. Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure. This e-mail message, including any attachments, is for the sole use of the 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 e-mail and destroy all copies of the original.
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