I just wanted to throw this out there as I have been rolling out our sepsis program in our facility.
In working with our Case Managers, I specifically looked through the Interqual Guidelines that qualify in-patient stays for a regular--- basic sepsis diagnosis. The qualifications are the exact same requirements as the SSC states that divides them into categories-The first basic sepsis dx is the two SIRS markers - meaning this could simply imply tachypnea and a hr >90bpm + 1 possible source of infection. This would qualify for a standard Sepsis diagnosis and insurance would reimburse based on those items alone. The other two categories do require more. For severe sepsis and septic shock: severe-- 1 sign of organ dysfunction with the previous stated and Septic Shock requiring the previous two + vasopressors to sustain MAP place them in higher levels of care. Often the source can be unknown: but if someone presents with cough and SOB and a chest x-ray is non-definitive - they still technically meet criteria and should be treated accordingly. Where the trick lies is in someone with something like strep throat. They may have a fever + tachycardia and their possible source is streptococcus - it's absurd to admit the patient who technically qualifies as "Septic". But, many issues with this roll out is that it will over diagnose patients but not under diagnose. There will be judgments that must be made, regardless there should not be any issue from any auditing source until those definitions change. In reviewing our own data we have seen MOST not diagnosed when they are admitted with anything infectious. Primarily pneumonia. We have engrained the cultures and abx pathway, but we have not concluded that these patients meet sepsis criteria. Because of this, our pneumonia death rate is extremely high. This would be adjusted if we could get clinicians to utilize the sepsis diagnosis more often. The other group who is not keen on the "sepsis" label are surgeons. If a patient is admitted with gangrene of his toe and has SIRS markers, they are most certainly septic. From what I read, even with appropriate treatment ---- not diagnosing this patient as "Septic" is a loss of at least $9,000. What have you all found? Anything different on your end? How have you dealt with this if so? Madison Vahle BSN, RN, SANE Clinical Educator CITIZENS MEMORIAL HOSPITAL 1500 North Oakland Bolivar, Missouri 65613-3099 Phone: 417-328-7957 Mobile: 417-414-1800 Email: [email protected] <mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Mitchell Levy Sent: Sunday, January 18, 2015 2:27 PM To: [email protected]; [email protected]; [email protected] Subject: 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 <tel:(850)%20863-2110> Cell: (850) 803-5854 <tel:(850)%20803-5854> Fax: (850) 864-4438 <tel:(850)%20864-4438> <tel:(850)%20864-4438> <tel:(850)%20864-4438> In a message dated 1/17/2015 9:45:57 A.M. Central Standard Time, [email protected] writes: <tel:(850)%20864-4438> <tel:(850)%20864-4438> 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. <tel:(850)%20864-4438> <tel:(850)%20864-4438> 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?! <tel:(850)%20864-4438> <tel:(850)%20864-4438> 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 <tel:(850)%20864-4438> <tel:(850)%20864-4438> 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"? <tel:(850)%20864-4438> <tel:(850)%20864-4438> Thank you in advance for your time and expertise! <tel:(850)%20864-4438> Claudia <tel:(850)%20864-4438> Claudia Orth BSN, RN, CCRN-K <tel:(850)%20864-4438> Regional Sepsis Coordinator <tel:(850)%20864-4438> Munson Medical Center <tel:(850)%20864-4438> (231) 935-5692 (Voice) <tel:(850)%20864-4438> [email protected] <tel:(850)%20864-4438> <tel:(850)%20864-4438> _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org <tel:(850)%20864-4438> _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _________________________________________
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