My reading is in line with what Mary Ann says, and taken from quotes from the Data Dictionary below. If patients meet either severe sepsis or septic shock criteria when they arrive at the ED, then the Triage time is time 0. If they do not meet the criteria when they arrive, then by definition, their time 0 is calculated the same way it will be calculated for all other patients in the hospital, the time in which their lab results or vitals sign define them as either severe sepsis or septic shock. Patients who present to the ED without organ dysfunction on arrival and develop it 6 hours later while still in ED do not have the triage time as time 0, but rather Triage time + 6 hours.
References : "For patients who enter the emergency department with septic shock, their Septic Shock Presentation time is the time they were triaged in the Emergency Department.” •Data Dictionary Page: 1-336 - Specifications Manual for National Hospital Inpatient Quality Measures "For patients who enter the emergency department with severe sepsis, their Severe Sepsis Presentation time is the time they were triaged in the Emergency Department.” •Data Dictionary Page: 1-339 - Specifications Manual for National Hospital Inpatient Quality Measures Ryan Arnold, MD Department of Emergency Medicine Value Institute Christiana Care Health System. > On Jun 2, 2015, at 12:43 PM, Barnes-Daly, Mary Ann > <[email protected]> wrote: > > It seems as though there will be 2 possible T-0 for the ED > 1. For those patients who meet criteria in triage (when first > encountered) Triage time = T – 0 > 2. For those patients who do not meet the above, but have the > “constellation of symptoms” documented sometime later in their ED stay, that > will be > T – 0 > > The 30ml/kg bolus is meant for patients with severe sepsis who have > hypotension and/or lactate > 4.0 as always > > 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] > > “You never change things by fighting the existing reality. To change > something, build a new model that makes the existing model obsolete.” > ~R. Buckminster Fuller > > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Brandy Cuevas > Sent: Friday, May 29, 2015 5:55 AM > To: Angela Craig; '[email protected]'; > [email protected] > Subject: Re: [Sepsis Groups] Joint Commission Performance Measure Time Zero > > I am also confused on Time Zero as it says patients entering through the ED, > the time of presentation is the time the patient is triaged. > > Also, Can anyone clarify the 30ml/kg for me. Is it your understanding that > any patient that presents with sepsis will get 30ml/kg regardless if they are > in septic shock or severe sepsis? > > Thanks in advance!! > > Brandy Cuevas, BSN, RN > Quality Improvement Coordinator > William Newton Hospital > 1300 E. 5th Ave. > Winfield, KS 67156 > 620-222-6225 > [email protected] <mailto:[email protected]> > > CONFIDENTIALITY NOTICE: This email communication may contain private, > confidential, or legally privileged information intended for the sole use of > the designated and/or duly authorized recipient(s). If you are not the > intended recipient or have received this email in error, please notify the > sender immediately by email and permanently delete all copies of this email > including all attachments without reading them. If you are the intended > recipient, secure the contents in a manner that conforms to all applicable > state and/or federal requirements related to privacy and confidentiality of > such information. > > From: Sepsisgroups [mailto:[email protected] > <mailto:[email protected]>] On Behalf Of Angela > Craig > Sent: Thursday, May 28, 2015 10:32 AM > To: '[email protected]'; [email protected] > <mailto:[email protected]> > Subject: [Sepsis Groups] Joint Commission Performance Measure Time Zero > > > > OK so most of us have changed to time of triage for time zero I would > assume. I had a meeting with our data abstractor for Sepsis Core Measures > yesterday and she mentioned time zero would be changing. She then showed me > the manual for the data abstractors. > > It stated for Septic Shock Present the following: Criteria > > There must be documentation of severe sepsis present AND > Tissue hypoperfusion persists after crystalloid fluid administration > evidenced by either SBP <90, or MAP<65, or a decrease in SBP by >40points OR > Lactate level is >4 > > Soooo My abstractor was under the impression this would be the new time zero > based on this. > > There was a sheet on Severe Sepsis Present as well. What concerns me is that > based on documentation is what will que them for time zero. I am worried > that there will be delays in care if that is how it will be determined. What > are everyone’s thoughts? > > Am I missing something? Will everyone just stay with time zero that we feel > is “clinically correct” and consistent across the country and just let core > measures monitor something different? Can someone help me understand this. > I really hope I am not reading something correctly or just not understanding. > > Thank you in advance - I am soo grateful for this List serve!!! > > Angela Craig APN,MS,CCNS > Clinical Nurse Specialist > Intensive Care Unit > Cookeville Regional Medical Center > 931-783-5035 > > > > > > > The materials in this email are private and may contain Protected Health > Information. If you are not the intended recipient, be advised that any > unauthorized use, disclosure, copying, distribution or the taking of any > action in reliance on the contents of this information is strictly > prohibited. If you have received this email in error, please immediately > notify the sender. > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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