Dr. Townsend, Thank you for your response. While I understand the rationale of providing the best care for every patient every time, I am really looking for clinical evidence to defend that bedside physician assessments correlate with measureable, superior care; my physicians are asking for a reason besides, the opinion of CMS is that “it’s just better this way.”
Thank you for discussing this issue with me. Respectfully, Gayle -----Original Message----- From: Townsend, Sean, M.D. [mailto:[email protected]] Sent: Tuesday, September 22, 2015 5:45 PM To: Porter Gayle Cc: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] Physician/ANP/PA Assessment The reason is that these patients are critically ill and the expectation of CMS is that patients accessing critical care services should be seen by a licensed provider skilled in assessing volume status and adequacy of perfusion. The expectation as well is that only a licensed provider can issue orders to react to inadequate perfusion. Relying on telephone communication and time delays associated with nursing report of information gathered second hand dilutes the information. In essence, "seeing is believing" and direct observation is more likely to result in well considered orders to correct underlying hypoperfusion. This is especially true in the early phases of a patient's critical illness where it is eminently reasonable that a patient be re-evaluated by trained eyes and hands. Imagine families' expectations as well that a loved one in the ICU needs to be seen only once, if at all, to be properly cared for? Not to put too much shame into the matter, but this is actually an instance where our habitual care patterns are exposed to reality and look pretty flimsy. Finally, it's worth remembering that rather than placing central lines and assessing cvp and scvo2 as a mandatory approach, providers are merely being asked to examine their patients. All that said, yes, many nurses are skilled and capable of assisting in this regard. Unfortunately, there are those who are not as well, and there is no way to eliminate the vagaries of second hand communication and delays in order writing with a nurse directed approach. Hope that helps a little bit. On Sep 22, 2015, at 3:31 PM, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> wrote: Hello, I am writing to query if there is any evidence-based reason why CMS is requiring a bedside physician assessment for septic shock patients, when the standard for other critically ill patients is typically based on a bedside nursing assessment that is reported to the physician by telephone. I work in an underserved minority population where physician access is challenging without the bedside assessment requirement, and I am curious if there is a rationale for this deviation from the norm. Thanks for your input, Gayle Porter, RN BSN Sepsis Program Coordinator Brownsville, TX _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[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
