We exclude hospice patients from our mortality data as well.
Gail Taylor, RN, MPH, CCRN
Corporate Administrator
Patient Care Integration
Methodist Le Bonheur Healthcare
1211 Union Avenue Suite 638
Memphis, TN 38104
Office: 901-516-0701 or
901-516-0749
Cell: 901-258-3349
Fax: 901-516-0794
[email protected]
Methodist Le Bonheur Healthcare is proud to once again
be named among the Top 100 Integrated Healthcare Networks
in the country.
"Be treated well."
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-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
[email protected]
Sent: Friday, January 17, 2014 12:20 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 92, Issue 2
Send Sepsisgroups mailing list submissions to
[email protected]
To subscribe or unsubscribe via the World Wide Web, visit
http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
or, via email, send a message with subject or body 'help' to
[email protected]
You can reach the person managing the list at
[email protected]
When replying, please edit your Subject line so it is more specific than "Re:
Contents of Sepsisgroups digest..."
Today's Topics:
1. Re: [Hospice patients in mortality data] (Brochis, Dale.)
2. Re: Sepsisgroups Digest, Vol 91, Issue 1
(Carlson, Barbara A. (Lincoln, NE))
----------------------------------------------------------------------
Message: 1
Date: Wed, 15 Jan 2014 13:28:48 -0500
From: "Brochis, Dale." <[email protected]>
To: "Cormack, Patricia \(WS\)" <[email protected]>, "Wendy A.
Nieman" <[email protected]>, "Robyn Haddock Crosswhite"
<[email protected]>, <[email protected]>
Subject: Re: [Sepsis Groups] [Hospice patients in mortality data]
Message-ID:
<[email protected]>
Content-Type: text/plain; charset="iso-8859-1"
There is ambiguity and confusion in the answers provided regarding capture of
mortality data, and unless clarified will never help identify a best practice,
or importantly, how to clearly measure it.
A hospice admission is not an inpatient acute care admission.
If mortality data is based upon inpatient acute care admissions, and if
all-cause mortality is not of value, then very clear definitions of the sepsis
patients for whom mortality IS to be captures must be developed, disseminated
and utilized.
Reporting of any mortality number should clearly describe the population
captured and all exclusions.
I agree that there is value in exploring who has expired - DNR status, Hospice
status, and why they expired. However, independent decisions by individual
organizations results in comparing different apples. I count all my apples,
and compare my organization against others that exclude only their Macintosh,
and another that excludes MacIntosh and Granny Smith.
It's not that this differentiation is wrong, it is that it is different - and
undermines statistical value.
?
Dale Brochis Gainsharing Project Coordinator Case Management Department Robert
Wood Johnson University Hospital?at Rahway
865 Stone Street
Rahway, NJ 07065
732-499-6217 Office / 732-428-2108 Cell
[email protected]
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Cormack,
Patricia (WS)
Sent: Monday, January 13, 2014 8:48 AM
To: Wendy A. Nieman; Robyn Haddock Crosswhite;
[email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
We do not include hospice patients in our mortality. Expected mortality.
Patty Cormack
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Wendy A.
Nieman
Sent: Friday, January 10, 2014 7:47 AM
To: Robyn Haddock Crosswhite; [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
Hello everyone
If the patient dies while an inpatient they would be included in our mortality
rate, regardless of Hospice status.
Wendy Nieman RN
ICU and Medical Quality Coordinator
St. Joeseph Mercy Hospital
Ann Arbor Michigan 48104
________________________________________
From: [email protected]
[[email protected]] on behalf of Robyn Haddock
Crosswhite [[email protected]]
Sent: Wednesday, January 08, 2014 12:03 PM
To: [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
Our hospital includes hospice discharges regarding sepsis patients in our
mortality rates, I just wanted to know if other hospitals are doing this as
well? Thanks
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
[email protected]
Sent: Monday, January 06, 2014 2:07 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 91, Issue 1
Send Sepsisgroups mailing list submissions to
[email protected]
To subscribe or unsubscribe via the World Wide Web, visit
http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
or, via email, send a message with subject or body 'help' to
[email protected]
You can reach the person managing the list at
[email protected]
When replying, please edit your Subject line so it is more specific than
"Re: Contents of Sepsisgroups digest..."
Today's Topics:
1. Re: Mortality (Angela Craig)
2. Re: First Dose Antibiotics (Rick Rutherford)
----------------------------------------------------------------------
Message: 1
Date: Fri, 3 Jan 2014 13:31:38 -0600
From: Angela Craig <[email protected]>
To: "'Michelle Corder'" <[email protected]>, "Philip S.
Barie" <[email protected]>, Hesham Hassaballa
<[email protected]>,
"<[email protected]>"
<[email protected]>
Subject: Re: [Sepsis Groups] Mortality
Message-ID:
<343E31412FC9094487B54371286ADDA003D404B937@D109EXCHMB.crmchealth.hospit
al>
Content-Type: text/plain; charset="windows-1252"
I think of it as "All Cause Mortality" so, no matter where they are when they
expire it counts
Angela Craig APN,MS,CCNS
Clinical Nurse Specialist
Intensive Care Unit
Cookeville Regional Medical Center
931-783-5035
________________________________
From: [email protected]
[mailto:[email protected]] On Behalf Of Michelle
Corder
Sent: Thursday, January 02, 2014 9:36 AM
To: Philip S. Barie; Hesham Hassaballa;
<[email protected]>
Subject: Re: [Sepsis Groups] Mortality
I have a question for the establishing mortality rate:
Do you include a patient that is transfered out of the ICU but later expires on
the floor in the mortality rate?
or
Do you only count the patients that expire while in the ICU?
Michelle Corder
PIH Health
________________________________
From: [email protected]
[[email protected]] On Behalf Of Philip S.
Barie [[email protected]]
Sent: Friday, December 27, 2013 10:39 AM
To: Hesham Hassaballa; <[email protected]>
Subject: Re: [Sepsis Groups] Mortality
Yes, unless you can prove it to be completely unrelated. Which, it seems as
though you cannot.
________________________________
From: [email protected]
[[email protected]] on behalf of Hesham Hassaballa
[[email protected]]
Sent: Tuesday, December 24, 2013 4:28 PM
To: <[email protected]>
Subject: [Sepsis Groups] Mortality
I have a question:
A patient was admitted with septic shock, and we successfully treated him and
he survived to ICU discharge. Approximately 17 days later, he codes and dies on
the floor (unknown reason why) the day before he was slated to be discharged
from the hospital.
Does this really count against our sepsis mortality?
Hesham A. Hassaballa, MD
Program Medical Director
Critical Care
Rush-Copley Medical Center
Assistant Professor of Medicine
Rush University Medical Center
Phone: (331) 454-6572
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------------------------------
Message: 2
Date: Sat, 4 Jan 2014 07:25:40 -0800
From: Rick Rutherford <[email protected]>
To: Sepsis List Serve <[email protected]>
Subject: Re: [Sepsis Groups] First Dose Antibiotics
Message-ID: <[email protected]>
Content-Type: text/plain; charset="iso-8859-1"
Hello All,
We are seeing resistance to giving antibiotics early in patients who meet criteria
for severe sepsis but do not have a source. The argument often goes like this:
"The patient is not critically ill and I do not have a source. Antibiotics
will cloud an unclear picture further and have side effects such as liver and renal
failure and breed resistance.
I am going to hold off on antibiotics unless a source becomes apparent."
Often, but not always, these patients will get their positive urine or blood
culture 2-3 days later and we will have been out of compliance and put the
patient at risk. Antibiotics noncompliance in nonshock septic patients is our
most common miss in the bundles.
I would appreciate help in formulating counterarguments to these concerns.
Especially useful would be articles demonstrating the safety of single doses of
antibiotics and the consequences of incorrect antibiotics in sepsis and severe
sepsis (Not Septic Shock which Dr.
Kumar and others have addressed nicely).
Thanks,
RIck RutherfordSepsis Task Force ChairVentura County Medical Center
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------------------------------
Message: 2
Date: Wed, 15 Jan 2014 18:29:59 +0000
From: "Carlson, Barbara A. (Lincoln, NE)" <[email protected]>
To: "Cormack, Patricia (WS)" <[email protected]>, "Wendy A.
Nieman" <[email protected]>, Robyn Haddock Crosswhite
<[email protected]>, "[email protected]"
<[email protected]>
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
Message-ID:
<35dbb1774783904fb66a013e4e110d3f2ce73...@chiex011.chi.catholichealth.net>
Content-Type: text/plain; charset="us-ascii"
Thoughts for the future...
I would consider that currently patients are excluded from the mortality
measure if they are hospice day 0.
>From CMS excluded population for mortality
"Admissions for patients enrolled in the Medicare Hospice Program any time in the 12
months prior to the index hospitalization including the first day of the index admission
since it is likely these patients are continuing to seek comfort measures only."
Also, if and when this measure is a CMS eMeasure, some abstraction in current
core measures is excluded if the patient is hospice/comfort care day 0-1.
Barbara Carlson RN
Performance Improvement
St Elizabeth Regional Medical Center
P 402-219-7332
F 402-219-8992
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Cormack,
Patricia (WS)
Sent: Monday, January 13, 2014 7:48 AM
To: Wendy A. Nieman; Robyn Haddock Crosswhite;
[email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
We do not include hospice patients in our mortality. Expected mortality.
Patty Cormack
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of Wendy A.
Nieman
Sent: Friday, January 10, 2014 7:47 AM
To: Robyn Haddock Crosswhite; [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
Hello everyone
If the patient dies while an inpatient they would be included in our mortality
rate, regardless of Hospice status.
Wendy Nieman RN
ICU and Medical Quality Coordinator
St. Joeseph Mercy Hospital
Ann Arbor Michigan 48104
________________________________________
From: [email protected]
[[email protected]] on behalf of Robyn Haddock
Crosswhite [[email protected]]
Sent: Wednesday, January 08, 2014 12:03 PM
To: [email protected]
Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 91, Issue 1
Our hospital includes hospice discharges regarding sepsis patients in our
mortality rates, I just wanted to know if other hospitals are doing this as
well? Thanks
-----Original Message-----
From: [email protected]
[mailto:[email protected]] On Behalf Of
[email protected]
Sent: Monday, January 06, 2014 2:07 PM
To: [email protected]
Subject: Sepsisgroups Digest, Vol 91, Issue 1
Send Sepsisgroups mailing list submissions to
[email protected]
To subscribe or unsubscribe via the World Wide Web, visit
http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
or, via email, send a message with subject or body 'help' to
[email protected]
You can reach the person managing the list at
[email protected]
When replying, please edit your Subject line so it is more specific than
"Re: Contents of Sepsisgroups digest..."
Today's Topics:
1. Re: Mortality (Angela Craig)
2. Re: First Dose Antibiotics (Rick Rutherford)
----------------------------------------------------------------------
Message: 1
Date: Fri, 3 Jan 2014 13:31:38 -0600
From: Angela Craig <[email protected]>
To: "'Michelle Corder'" <[email protected]>, "Philip S.
Barie" <[email protected]>, Hesham Hassaballa
<[email protected]>,
"<[email protected]>"
<[email protected]>
Subject: Re: [Sepsis Groups] Mortality
Message-ID:
<343E31412FC9094487B54371286ADDA003D404B937@D109EXCHMB.crmchealth.hospit
al>
Content-Type: text/plain; charset="windows-1252"
I think of it as "All Cause Mortality" so, no matter where they are when they
expire it counts
Angela Craig APN,MS,CCNS
Clinical Nurse Specialist
Intensive Care Unit
Cookeville Regional Medical Center
931-783-5035
________________________________
From: [email protected]
[mailto:[email protected]] On Behalf Of Michelle
Corder
Sent: Thursday, January 02, 2014 9:36 AM
To: Philip S. Barie; Hesham Hassaballa;
<[email protected]>
Subject: Re: [Sepsis Groups] Mortality
I have a question for the establishing mortality rate:
Do you include a patient that is transfered out of the ICU but later expires on
the floor in the mortality rate?
or
Do you only count the patients that expire while in the ICU?
Michelle Corder
PIH Health
________________________________
From: [email protected]
[[email protected]] On Behalf Of Philip S.
Barie [[email protected]]
Sent: Friday, December 27, 2013 10:39 AM
To: Hesham Hassaballa; <[email protected]>
Subject: Re: [Sepsis Groups] Mortality
Yes, unless you can prove it to be completely unrelated. Which, it seems as
though you cannot.
________________________________
From: [email protected]
[[email protected]] on behalf of Hesham Hassaballa
[[email protected]]
Sent: Tuesday, December 24, 2013 4:28 PM
To: <[email protected]>
Subject: [Sepsis Groups] Mortality
I have a question:
A patient was admitted with septic shock, and we successfully treated him and
he survived to ICU discharge. Approximately 17 days later, he codes and dies on
the floor (unknown reason why) the day before he was slated to be discharged
from the hospital.
Does this really count against our sepsis mortality?
Hesham A. Hassaballa, MD
Program Medical Director
Critical Care
Rush-Copley Medical Center
Assistant Professor of Medicine
Rush University Medical Center
Phone: (331) 454-6572
### CONFIDENTIALITY NOTICE ###
This message and any included attachments are from Cogent HMG and are intended only
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### CONFIDENTIALITY NOTICE ###
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------------------------------
Message: 2
Date: Sat, 4 Jan 2014 07:25:40 -0800
From: Rick Rutherford <[email protected]>
To: Sepsis List Serve <[email protected]>
Subject: Re: [Sepsis Groups] First Dose Antibiotics
Message-ID: <[email protected]>
Content-Type: text/plain; charset="iso-8859-1"
Hello All,
We are seeing resistance to giving antibiotics early in patients who meet criteria
for severe sepsis but do not have a source. The argument often goes like this:
"The patient is not critically ill and I do not have a source. Antibiotics
will cloud an unclear picture further and have side effects such as liver and renal
failure and breed resistance.
I am going to hold off on antibiotics unless a source becomes apparent."
Often, but not always, these patients will get their positive urine or blood
culture 2-3 days later and we will have been out of compliance and put the
patient at risk. Antibiotics noncompliance in nonshock septic patients is our
most common miss in the bundles.
I would appreciate help in formulating counterarguments to these concerns.
Especially useful would be articles demonstrating the safety of single doses of
antibiotics and the consequences of incorrect antibiotics in sepsis and severe
sepsis (Not Septic Shock which Dr.
Kumar and others have addressed nicely).
Thanks,
RIck RutherfordSepsis Task Force ChairVentura County Medical Center
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