This is what I am been predicting!
I have spoke directly with Dr Levy on several occasions and he maintains
if you have TWO sustained abnormalities of the SIRS criteria and not due
to a non- inflammatory condition then he and the literature states that is
sepsis... and this should stand with external reviewers.
However, as a clinician I have trouble with this and I am sure I have a
lot of patients with acute infective bronchitis who meet the criteria for
sepsis in my office that I send home on antibiotics...Hardly are they septic!
So at least make sure that the SIRS criteria are sustained till
treatment is begun and not just a triage VS done in the ER. I also (unlike Dr
Levy's advice) don't count an increased heart rate or RR in patients who are
hypoxic, as in pneumonia.
Good luck!
William E. Haik, M.D., F.C.C.P., C.D.I.P.
AHIMA Approved ICD-10-CM/PCS Trainer
Office: _(850) 863-2110_ (tel:(850)%20863-2110)
Cell: _(850) 803-5854_ (tel:(850)%20803-5854)
Fax: (850) 864-4438
In a message dated 1/17/2015 9:45:57 A.M. Central Standard Time,
[email protected] writes:
I am writing to inquire how other institutions are handling or if you are
even encountering concerns, that we are “over-calling” early sepsis,
especially when the only SIRS criteria are tachycardia and tachypnea
(sometimes
only a single set of VS). We are reviewing all short stay (Observation,
1-2 day stays) and see “septic” patients who are “in no acute distress”,
are only here in Observation status and never Inpatient, or stay as IP only
1-2 days, are not sent home on any antibiotics or only a short course of
oral antibiotics.
Often their only SIRS criteria are tachycardia and tachypnea—which are
quite non-specific markers that can be seen with anxiety, pain, etc. but when
paired with a suspected or documented infection role up to Sepsis?!
Since Sepsis is a high-paying condition it’s also a high audit DRG (mainly
because, in the past, many patients were in I_CU, very ill, and expending
lots of resources). Now that “early sepsis” is being diagnosed quite
frequently, external auditors are reviewing sepsis DRG charts, and disagree
that
sepsis was present at all, recode the chart, reassign the DRG and reduce
payment to UTI, pneumonia, etc. This is so frustrating as we are trying to
educated our providers and nurses on the importance of having a high
suspicion for sepsis and early recognition and now are turning around and
saying
don’t say ‘Sepsis’ unless they are “sick” because we need to be able to
defend it!? L
Any feedback, thoughts, or tools on how other institutions are handling
this, would be greatly appreciated especially when it comes to the SIRS
criteria which most of our clinicians call “soft criteria”?
Thank you in advance for your time and expertise!
Claudia
Claudia Orth BSN, RN, CCRN-K
Regional Sepsis Coordinator
Munson Medical Center
(231) 935-5692 (Voice)
_ (tel:(850)%20864-4438) [email protected]_ (mailto:[email protected])
(tel:(850)%20864-4438)
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