Great Dr Levy ! tell us the results! Otherwise , at least in the ICU / ER we have to escalate definitions . Many thanks andrea de gasperi md _____________________________________________ Azienda Ospedaliera "Ospedale Niguarda Ca' Granda" Dipartimento Chirurgico Polispecialistico S.C. Anestesia e Rianimazione 2 Direttore Dr. Andrea De Gasperi Segreteria Direttore:'02 6444.4617 702 6444.4891 Segreteria Degenza: '02 6444.2553 702 6444.2907 Mail personale [email protected] Attenzione "Le informazioni contenute in questo messaggio e-mail sono destinate esclusivamente alla persone o entità cui è stato indirizzato e può contenere informazioni riservate. Ogni reinvio, diffusione o altro utilizzo o qualunque azione basata sul presente messaggio da parte di persone o entità diverse dal destinatario, se non espressamente autorizzate dal mittente, sono proibiti. Se avete ricevuto questo messaggio per errore, siete pregati di contattare immediatamente il mittente via e-mail e di cancellarlo da ogni vostro computer". Grazie. Disclaimer "The information transmitted in this e-mail message is intended only for the person or entity to which it is addressed and may contain confidential information. Any retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by person or entity other than the intended recipient, if not clearly authorized by the sender, is prohibited. If you have received this communication in error, please notify the sender immediately by e-mail and delete the message from any computer". Thank you.
________________________________ Da: Sepsisgroups per conto di Mitchell Levy Inviato: dom 18/01/2015 21.26 A: [email protected]; [email protected]; [email protected] Oggetto: Re: [Sepsis Groups] SIRS/Sepsis Criteria and Coding By the current definition, sepsis is defined at 2/4 SIRS + documented or suspected infection. So yes, even mild bronchitis by that definition is "sepsis." Most clinicians use "sepsis" as synomous with Severe Sepsis, which includes organ dysfunction. Having said that, there is a task force that has been re-visiting the definitions of sepsis. We have been meeting for the past year, and the results will be presented today at SCCM meeting in Phoenix. Stay tuned..... Mitchell From: <[email protected]> Date: Saturday, January 17, 2015 at 12:16 PM To: <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] SIRS/Sepsis Criteria and Coding 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 Cell: (850) 803-5854 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 ICU, 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) [email protected] _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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