Good morning, everyone! Would you be willing to share your hospital's admission criteria for septic/potentially septic patients? Given that there are numerous reasons for a lactic acid level to be elevated and therefore the patient may not have sepsis solely based on the elevated lactate alone, we are receiving much push back from our Intensivists for accepting patients into the ICU. Our physician Sepsis champions (an Intensivist, Hospitalist and ED physician) have not attended our monthly sepsis meetings, so we put protocols into place utilizing nursing staff and the medical director but are now receiving much questioning and encountering issues (for example, our hospitalists are admitting patients to the ICU, which makes them "overflow."
The criteria we had decided upon was a lactate level >4 and 2 or more SIRS criteria warranted an ICU bed for 24 hours. If the patient did well after the 3 and 6 hour bundles were met and was stable with a declining lactate level, they could then be transferred out of the ICU. We created a screening tool that was put into place a week ago. There is a loophole that was noted yesterday with a patient that came through the ED, had an initial lactate of 4.9 followed several hours later with an increase to 5.6 and one positive SIRS criteria, along with a possible abdominal infection. The intensivist refused ICU admission and emailed the critical care director asking why the nursing supervisor insisted on an ICU admission. According to what we had stated, this patient didn't meet criteria for ICU with only one SIRS criteria, but did have an increasing lactate level. The patient was NOT hypotensive. I would deeply appreciate your thoughts. Thank you in advance!
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
