Mary-Ann, We are not at this point yet. Pretty much, those in septic shock and those unresponsive to fluids go to ICU. We are, however, working on severe sepsis and uncomplicated sepsis going to a tele floor.
Juanita Fernandes, RN, BSN, CEN Emergency Department Nurse Educator Concord Hospital 250 Pleasant Street Concord, New Hampshire 03301 (603) 227-7000 ext. 3138 Pager (603) 221-1104 >>> On 9/24/2014 at 10:57 PM, "Barnes-Daly, Mary Ann" >>> <[email protected]> wrote: I have been following this thread and an interested in how patients receive the 6 hour bundle - specifically EGDT - for which they qualify if they are not admitted to the ICU. Septic shock, and cryptic shock (Lactate >3.9) has a very strong signal for this level of care. Many health systems and hospitals are not only admitting this cohort of patients to the ICU, they are also admitting severe sepsis patients (with no defined shock) to the ICU with significant reductions in mortality. Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Clinical Integration Department | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Boyd, Melissa Sent: Wednesday, September 24, 2014 4:54 AM To: Lisa Dumont; [email protected] Subject: Re: [Sepsis Groups] protocol for severe sepsis. ICU admit Good morning! We have had the same issues. Our intensivists are very reluctant to admit to ICU based solely on an elevated lactate >4. Together we have tried to work on a better way to narrow these patients down. We are currently admitting to the ICU if the patient has 2 or more SIRS criteria, a lactate >2 and 1 organ dysfunction criteria. Haven't been using this long enough to see results, but we are hoping that this criteria catches our septic patients early enough to decrease mortality rates and show significant improvement in outcomes. Melissa Boyd, RN -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Lisa Dumont Sent: Tuesday, September 23, 2014 8:02 AM To: [email protected] Subject: Re: [Sepsis Groups] protocol for severe sepsis. ICU admit Dear Group, I have been reading on this list-serve that many of us are looking for a protocol for severe ICU patients. I am in a situation where our intensivist, our director of the ED and director of the hospitalist service agree that if a septic patient is stable and has a LA > 4, the patients does not have to go to the ICU. I am concerned about this and I would like a solid protocol. Currently, we reduced our mortality significantly and had only 2 mortalities in the last few months in the LA >4 range. I am not sure if they are letting their guard down or have a false sense of security. I would anyone who has a good solid protocol for this type of admission, please email me. Thank you in advance, I will take any advise. Lisa Lisa Dumont RN MSN Sepsis Coordinator-SHG Saint Luke's Hopsital 101 Page St. New Bedford MA 02740 Phone 508-997-1515 Ext. 5833 [email protected] www.facebook.com/southcoasthealth | @SouthcoastHosp -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, September 18, 2014 3:53 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 126, 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. Neutropenic Patients (Colt Shope) 2. ED to ICU protocol (Brown, Sheree) ---------------------------------------------------------------------- Message: 1 Date: Tue, 16 Sep 2014 13:35:06 +0000 From: Colt Shope <[email protected]> To: "[email protected]" <[email protected]> Subject: [Sepsis Groups] Neutropenic Patients Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" Can anyone send me recent literature on Sepsis Management with Neutropenic patients? I can't seem to find any and my oncology floor has a lot of questions that I'm unsure how to answer. Thank you. Colt F. Shope, RN, BSN Sepsis Coordinator Greenville Health System 701 Grove Road Greenville SC, 29605 [email protected]<mailto:[email protected]> (864) 455-6319 Always Strive for Excellence. ***The information in this communication is intended to be confidential to the individual(s) and/ or Entity to whom it is addressed. It may contain information of a Privileged and/or Confidential nature, which is subject to Federal and/or State privacy regulations. In the event that you are not the intended recipient or the agent of the intended recipient, do not copy or use the information contained within this communication, or allow it to be read, copied or utilized in any manner, by any other person(s). should this communication be received in error, please notify the sender immediately either by response e-mail or by the phone at (864) 455-6319, and permanently delete the original e-mail, attachment(s) and any copies.*** -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140916/01d625d8/attachment.html> ------------------------------ Message: 2 Date: Wed, 17 Sep 2014 12:23:56 -0400 From: "Brown, Sheree" <[email protected]> To: "'[email protected]'" <[email protected]> Subject: [Sepsis Groups] ED to ICU protocol Message-ID: <ad1f97859f676346bcb78c28e418d718022f33ae9...@exchange1.wafoote.org> Content-Type: text/plain; charset="us-ascii" We are developing a protocol for all of our severe sepsis patients with either hypotension or lactate >4 to go expeditiously to the ICU for initial resuscitation...similar to the way we get acute MIs on their way to the cath lab in a hurry. We are trying to reduce ED length of stay and urgent transfers to ICU within several hours of admission to non-ICU units. Does anyone have a similar protocol that you could share? or guidelines related to sepsis ICU admission criteria? Thanks, Sheree -- Sheree Brown MSN, RN, CNL Manager, Performance Excellence Phone: 517 788-4800 ext. 4209 Pager: 517 534-0127 Fax: 517 788-4715 [email protected]<allegiancehealth.org> [cid:[email protected]] ________________________________ This e-mail message and any attachment(s) is intended only for the individual(s) to whom it is addressed and may contain information that is privileged, confidential or proprietary in nature. Any unauthorized disclosure, copying or distribution of this e-mail or the content of this message is prohibited. If you have received this e-mail message in error, please immediately notify the sender at the e-mail address above, permanently delete this e-mail and destroy any copies of this e-mail and attachments in your possession. 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