Continuing what Robin stated regarding "clock ticking", the data collected should provide you with enough valid information to determine if your process for triage, sepsis screening and recognition are hardwired, consistent, valued and upheld.
Taking triage time or time of recognition is valuable only if you know what was looked for at those particular times. It's not about falling out of sepsis core measures - it about WHY you fall out in sepsis core measures. It's not about physician confidence in sepsis diagnosis taking hours - it's why took you hours to determine it. Unless the urgency of diagnosis becomes culturally ingrained along with those of AMI and Stroke, we will be continually arguing the validity of these defined points in time. Respectfully, Dale Dale Brochis, Lean Health Care Certified, Six Sigma Green Belt Purdue Healthcare TAP Case Management Department Robert Wood Johnson University Hospital at Rahway 865 Stone Street Rahway, NJ 07065 732-499-6217 Office / 732-428-2108 Cell [email protected]<mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Myran, Robin Sent: Friday, June 12, 2015 7:45 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 159, Issue 4 This whole conversation has been fascinating, and I appreciate all of the expert viewpoints. CMS wording: For patients who enter the Emergency Department with severe sepsis, the Severe Sepsis Presentation Time is the time they were triaged in the Emergency Department. Although the words "enter with" seem clear, I actually believe that they meant to capture the essence of the SSC's position on Time Zero in the ED (available at http://www.survivingsepsis.org/SiteCollectionDocuments/Time-Zero.pdf), which basically states that triage time should be considered Time Zero no matter when the patient actually meets severe sepsis criteria. They go on to say: Time zero based solely on physician diagnosis will miss the opportunity to clearly identify the time period leading up to diagnosis, a period that establishes the best target for performance improvement. Without recognition that the clock is ticking, there is no incentive to recognize a challenging diagnosis early. Despite best intentions, patient care may be compromised. We currently track "Triage Time" as well as "Time of Recognition". Robin Myran, MSN, RN, PCCN Sepsis Coordinator Hoag Memorial Hospital Presbyterian One Hoag Drive Newport Beach, CA 92658 Office: (949) 764-4588 Fax: (949) 764-5387 Cell: (949) 300-9137 [email protected]<mailto:[email protected]> -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Izard, Kimberly Sent: Tuesday, June 02, 2015 1:29 PM To: [email protected]<mailto:[email protected]>; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 159, Issue 4 According to the specifications manual from CMS, triage time is not "time zero" unless severe sepsis or septic shock is documented on arrival. There must be physician/NP/PA documentation of severe sepsis or septic shock, or the criteria must be met (within 6 hours of each other). If "time zero" is take to early (inaccurately), then it is possible to fail the sepsis bundles for core measure. Our docs will not treat a patient for sepsis unless they feel they are truly septic. In other words, they will not start the 'clock' until diagnosis is made which may be hours after triage time. Thank you, Kim Kim Izard, BS, RN Supervisor Clinical Outcomes/Core Measures SSM Health - St. Louis Network 1015 Corporate Square Drive Suite 240 Creve Coeur, MO 63132 Office - 314-989-2137 Cell - 618-670-3616 [email protected]<mailto:[email protected]> "Change is a challenge and an opportunity; not a threat" -Prince Phillip of England This e-mail message is confidential, intended only for the named recipient(s) above and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s) please notify the sender at the e-mail address or telephone number above and delete this e-mail from your computer. Thank you! -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Tuesday, June 02, 2015 11:47 AM To: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 159, Issue 4 We are using triage as time zero. I don't want to wait till a patient crumps 2 hours later before we start treating them. Jennifer Rieske RN, CCRN, SCRN Sepsis Coordinator Swedish Medical Center 601 E. Hampden Ave Suite 220 Englewood, CO 80113 Phone 303-788-5206 Pager 303-234-7060 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Tuesday, June 02, 2015 10:44 AM To: [email protected]<mailto:[email protected]> Subject: [EXTERNAL] Sepsisgroups Digest, Vol 159, Issue 4 Send Sepsisgroups mailing list submissions to [email protected]<mailto:[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]<mailto:[email protected]> You can reach the person managing the list at [email protected]<mailto:[email protected]> When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Joint Commission Performance Measure Time Zero ([email protected]<mailto:[email protected]>) 2. Re: Joint Commission Performance Measure Time Zero (Barnes-Daly, Mary Ann) ---------------------------------------------------------------------- Message: 1 Date: Mon, 1 Jun 2015 12:57:48 +0000 From: <[email protected]<mailto:[email protected]>> To: <[email protected]<mailto:[email protected]>>, <[email protected]<mailto:[email protected]>>, <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Joint Commission Performance Measure Time Zero Message-ID: <38902089313ea545b2fe24cf7fe874de11590...@xrdcwpmsghcmd1a.hca.corpad.net<mailto:38902089313ea545b2fe24cf7fe874de11590...@xrdcwpmsghcmd1a.hca.corpad.net>> Content-Type: text/plain; charset="utf-8" It does say that time zero will be triage if diagnosed in ER ? so that will remain the same. It is in the manual somewhere?we have reviewed this closely here at SMC/TMC. Jennifer From: Sepsisgroups [mailto:[email protected]] On Behalf Of Angela Craig Sent: Thursday, May 28, 2015 11:32 AM To: Borden Megan; [email protected]<mailto:[email protected]> Subject: [EXTERNAL] [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 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20150601/1b8f3107/attachment-0001.htm> ------------------------------ Message: 2 Date: Tue, 2 Jun 2015 09:43:52 -0700 From: "Barnes-Daly, Mary Ann" <[email protected]<mailto:[email protected]>> To: 'Brandy Cuevas' <[email protected]<mailto:[email protected]>>, 'Angela Craig' <[email protected]<mailto:[email protected]>>, "'[email protected]'" <[email protected]<mailto:[email protected]>>, "'[email protected]'" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Joint Commission Performance Measure Time Zero Message-ID: <e6878da068c4dd4699740e87596a168b0c483b2...@dcbl115vx.root.sutterhealth.org<mailto:e6878da068c4dd4699740e87596a168b0c483b2...@dcbl115vx.root.sutterhealth.org>> Content-Type: text/plain; charset="utf-8" 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]<mailto:[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]<mailto:[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]<mailto:[email protected]%3cmailto:[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]] On Behalf Of Angela Craig Sent: Thursday, May 28, 2015 10:32 AM To: '[email protected]'; [email protected]<mailto:[email protected]<mailto:[email protected]%3cmailto:[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. -------------- next part -------------- An HTML attachment was scrubbed... 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