At St Joseph Mercy Hospital, Ann Arbor, we have defined Time Zero as "SBP less than 90mmHG or 40 mmHG decrease from baseline after 30m/kg fluid bolus (we allow 1 hr for the bolus to be delivered); or requires vasopressors or intial lacitc acid is greater than or equal to 4mEq/L."
Cathy Stewart RN, BSN, CCRN Clinical Research Nurse Quality Benchmarking & External Reporting Phone: 734-712-1364 FAX: 734-712-7099 [email protected]<mailto:[email protected]> This is a confidential professional/peer review and quality improvement document of Saint Joseph Mercy Health System and the Trinity Health system of providers. It is protected from disclosure pursuant to the provisions of MCL 333.20175, 333.21513, MCL 333.21515, MCL 333.16222, MCL 331.531, MCL 331.533, MCL 330.1748, MCL 330.1143a, and other state laws as well as the Federal Patient Safety and Quality Improvement Act, 42 U.S.C. 299b-21-b-26 and other federal laws. Unauthorized disclosure or duplication is absolutely prohibited. ________________________________ From: [email protected] [[email protected]] on behalf of Erin Tallon [[email protected]] Sent: Tuesday, March 11, 2014 2:26 AM To: Suriving Sepsis Campaign Listserve Subject: [Sepsis Groups] Time Zero for patients transferred from the floor to the ICU I would like to ask if anyone here can tell me how they determine the time that should be used as Time Zero for those patients who are transferred to the ICU from either the floor or an IMC unit. I understand that for septic patients admitted through the ED, Time Zero is generally considered to be the time of ED registration. However, I am asking here about those patients who present with sepsis symptoms elsewhere in the hospital and need to be transferred to the ICU. What time do you consider to be Time Zero? Is it the time at which the onset of hypotension is first charted? Or do you use some other indicator? Since hypotension is not always the first sign of severe sepsis, it seems that the time of onset of hypotension (while perhaps the "easiest" indicator to use) is not always the best time to use in establishing a Time Zero. I am interested to know if hypotension onset or some different criteria is thought to be best in establishing a Time Zero for these patients. Also, for those working in the ED, what have your experiences been with using ED registration time as Time Zero? Has doing so (rather than using, say, the time of hypotension onset) helped to improve sepsis recognition/treatment times? Thanks, Erin Tallon, RN, BSN Memorial Medical Center (Springfield, IL) Critical Care Sepsis Team
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