My understanding is clock starts when the patient meets the septic shock criteria, not triage time and not screening time.
Sent from my iPad > On Feb 5, 2016, at 7:25 AM, "[email protected]" > <[email protected]> wrote: > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > > or, via email, send a message with subject or body 'help' to > [email protected] > > You can reach the person managing the list at > [email protected] > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Sepsis start time (McDonagh, Annmarie) > 2. Re: Septic Shock Presentation Time (Belfi, Karen) > 3. Re: Septic Shock Presentation Time (Belfi, Karen) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 4 Feb 2016 02:16:52 +0000 > From: "McDonagh, Annmarie" <[email protected]> > To: "[email protected]" > <[email protected]> > Subject: [Sepsis Groups] Sepsis start time > Message-ID: <[email protected]> > Content-Type: text/plain; charset="us-ascii" > > > It is my understanding that the sepsis clock in triage for implementing the > bundle starts when patient is seen in triage. If the screen is negative and 2 > hours later based on reassessment of the patient becomes positive due to > change in clinical condition. Does the clock start on the primary assessment > or the second? > Sent from my iPhone > > ------------------------------ > > Message: 2 > Date: Tue, 2 Feb 2016 07:45:55 -0500 > From: "Belfi, Karen" <[email protected]> > To: "Osburn, Jennifer R. RN" <[email protected]>, "Cobb, > Amy L." <[email protected]>, "Townsend, Sean, M.D. > ([email protected])" <[email protected]> > Cc: "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="utf-8" > > They did not specify. Everything I've read states that if crystalloid fluid > isn't given, then you do not select yes for septic shock. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Osburn, Jennifer R. RN > Sent: Friday, January 29, 2016 12:02 PM > To: Cobb, Amy L.; Townsend, Sean, M.D. ([email protected]) > Cc: [email protected] > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > > The Q&A from the CMS presentation in October, as noted below, notes that if > fluids were not administered then the answer to septic shock present is NO. > My understanding has been that this was the issue if the patient was > hypotensive NOT if septic shock was due to the lactic acid. (See question > 158 noted below) Is my assumption incorrect? > > Question 158 > What if the patient's initial lactate level is greater than 4? Is septic > shock present time the same as the severe sepsis present in this case if > fluids have not yet been administered? > > Answer to this question states (only part of answer) - Determination of > septic shock based upon a lactate ?4 does not require crystalloid fluid > administration to determine the presence of septic shock. > > > Example: > The patient meets SIRS criteria at 0600 and has documented infection at 0800 > but the 1st documented organ dysfunction is a lactic acid of 6.0 at 0900. > > My question: > 1. Severe sepsis presentation is 0900 since lactic acid is >2? > 2. Septic shock presentation is 0900 also even though fluids have not been > given yet? > > Thanks > > > Jennifer Osburn, RN, BSN > Quality and Accreditation > St. Mary's Medical Center > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Belfi, Karen > Sent: Thursday, January 28, 2016 6:56 AM > To: Cobb, Amy L.; Townsend, Sean, M.D. > Cc: [email protected] > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > > There is a bullet point in 5.0b that states if crystalloid fluids are not > given, to select value 2 (no). > Here are some questions from the Q&A from the CMS presentation in October > that clarifies the issue. > > Question 159: > > If no crystalloid fluids were administered, the answer to septic shock > present is no even if the physician documents septic shock? > > Answer 159: > > Correct. > > > > Question 161: > > If there is MD documentation of "possible septic shock" but no crystalloid > fluids were administered or were not administered at 30 ml/kg, would I answer > the "Septic Shock Present" data element as a "No?" > > Answer 161: > > > If no fluids were given after the presentation of severe sepsis, you would > select "No" for Septic Shock Present, regardless of physician documentation > or clinical criteria. If fluids were given but not 30 ml/kg, you would select > "Yes" for Septic Shock Present because of the physician documentation of > possible septic shock. > > > > Question 176: > > If the physician states septic shock in their notes but no crystalloid fluids > were administered, do we select "Yes" or "No" for septic shock? > > Answer 176: > > If no crystalloid fluids were given after presentation of severe sepsis, you > would select "No" for Septic Shock Present, regardless of how septic shock is > identified. > > > > Question 144: On slide 103, the Specifications Manual says: "If there has > not been crystalloid administration, select "No" for septic shock. Patients > with initial lactate >4 and severe sepsis present have septic shock without > the administration of crystalloids." Is this being addressed in the manual > page 1-332? > > Answer 144: > > For purposes of the SEP-1 measure, if crystalloid fluids were not given > following presentation of severe sepsis, you should select "No" for Septic > Shock Present. This allows the case to be excluded from the crystalloid fluid > data elements. The case would fail if crystalloid fluids were not given. This > does not mean the patient does not clinically have septic shock > > > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > > > -----Original Message----- > From: Cobb, Amy L. [mailto:[email protected]] > Sent: Thursday, January 28, 2016 6:45 AM > To: Townsend, Sean, M.D.; Belfi, Karen > Cc: [email protected] > Subject: RE: [Sepsis Groups] Septic Shock Presentation Time > > Has something changed in the Spec Manual since the v5.0b came out? This is > copied and pasted from the manual: > > *If criteria for Septic Shock are not met, but there is physician/APN/PA > documentation of Septic Shock, choose Value ?1.? > > Allowable Values: > 1 (Yes) There is documentation of Septic Shock > 2 (No) There is no documentation of Septic Shock, or unable to determine > > Dr. Townsend, can you clarify this if physician documentation is not enough > and let us know if this was changed/updated? > > Thank you > > > Amy Cobb RN, BSN > Sepsis Coordinator > Research Outcomes > Morton Plant Hospital > MS #73 > 300 Pinellas St. > Clearwater, FL 33756 > 727-298-6953 (Desk) > 727-462-3638 (Fax) > [email protected] > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Townsend, Sean, M.D. > Sent: Monday, January 25, 2016 4:12 PM > To: Belfi, Karen > Cc: [email protected] > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > > I don't see criteria met at 10:47. MD say so is not enough. > > > > On Jan 25, 2016, at 1:02 PM, Belfi, Karen > <[email protected]<mailto:[email protected]>> wrote: > > > > 10:47 would be septic shock time. It?s the earliest time criteria is met. > > > > Karen Belfi, RN, MSN > > Quality Outcomes Coordinator > > Lankenau Medical Center > > 484-476-8092 > > Pager: 5240 > > <image001.png> > > > > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected]<mailto:[email protected]> > > Sent: Wednesday, January 20, 2016 9:15 PM > > To: > [email protected]<mailto:[email protected]> > > Subject: [Sepsis Groups] Septic Shock Presentation Time > > > > Clinical criteria for severe sepsis is met at 1002. Crystalloid bolus > completed at 1247. SBP=79 @ 1300. SBP=87 @1330. > > Initial lactic acid =4.0 resulted at 1126. > > ED physician note started at 1047 containing documentation of possible septic > shock. > > Would septic shock presentation time be 1047, 1126 or 1300? > > > > Karen King, RN MSN > > Quality Management Core Measures Specialist, Lead > > Lakeview Regional Medical Center > > 95 Judge Tanner Boulevard > > Covington, LA 70433 > > Office: (985) 867-4467 > > Cell: (985) 788-0585 > > Fax: (985) 867-4263 > > Email: [email protected]<mailto:[email protected]> > > > > This email and any files transmitted with it may contain privileged or > confidential information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error and > that any use, dissemination, distribution, forwarding, printing, or copying > of this email or any attached files is strictly prohibited. If you have > received this email in error, please immediately purge it and all attachments > and notify the sender by reply email or contact the sender at the number > listed. > > > > > > > > _______________________________________________ > > Sepsisgroups mailing list > > [email protected]<mailto:[email protected]> > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= > > ---------------------------------------------------------------------- > Confidential: This electronic message and all contents contain information > from BayCare Health System which may be privileged, confidential or otherwise > protected from disclosure. The information is intended to be for the > addressee only. If you are not the addressee, any disclosure, copy, > distribution or use of the contents of this message is prohibited. If you > have received this electronic message in error, please notify the sender and > destroy the original message and all copies. > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > > Important Notice: This e-mail message and any attachments are from the above > sender at St. Mary?s Medical Center and are intended solely for the > individual or entity to which it is addressed and may contain information > that is privileged, confidential and exempt from disclosure under applicable > law. If you are not the intended recipient of this communication or the > employee or agent responsible for delivering the message to the intended > recipient, or if it has been sent to you in error, please notify the sender > immediately. Do not examine, review, use, disclose, deliver, distribute, > reproduce or take any action in reliance on it and immediately delete the > message and any attachments. > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > > ------------------------------ > > Message: 3 > Date: Tue, 2 Feb 2016 07:49:24 -0500 > From: "Belfi, Karen" <[email protected]> > To: "Miller, Nicole" <[email protected]>, > "[email protected]" > <[email protected]>, > "[email protected]" <[email protected]>, > "[email protected]" <[email protected]> > Cc: "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > Message-ID: > <[email protected]> > Content-Type: text/plain; charset="utf-8" > > According to the power point from October, you would take the severe sepsis > time for both severe sepsis and septic shock. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > > > > -----Original Message----- > From: Miller, Nicole [mailto:[email protected]] > Sent: Monday, February 01, 2016 12:16 PM > To: Belfi, Karen; [email protected]; [email protected]; > [email protected] > Cc: [email protected] > Subject: RE: [Sepsis Groups] Septic Shock Presentation Time > > Can I get some assistance on this presentation time for Severe Sepsis/Shock? > Source of infection at 07:51 > Two SIRS at 07:25 and 07:40 > Organ dysfunction at 07:12 > Severe Sepsis time=07:51---however, the organ dysfunction is a lactate of > 5.1. Do I take the Septic Shock time as 07:51 since I can't say I have > Septic Shock without a source of infection? Thank you! > > Nicole Miller, BSN, RN, CPHQ | PI Coordinator Edward-Elmhurst Healthcare | > 801 South Washington, Naperville, IL 60540 > (630) 527-5565 | HealthyDriven.com > > > This message is intended for the use of the person or entity to which it is > addressed and may contain information that is privileged and confidential, > the disclosure of which is governed by applicable law. If the reader of this > message is not the intended recipient, or the employee or agent responsible > to deliver it to the intended recipient, you are hereby notified that any > dissemination, distribution or copying of this information is STRICTLY > PROHIBITED. If you have received this message in error, please notify us > immediately and destroy the related message. CONFIDENTIALITY NOTICE: E-EH > System Patient Safety Work Product (PSWP). For use by authorized individuals > only. DO NOT COPY or DO NOT DISSEMINATE. > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Belfi, Karen > Sent: Friday, January 29, 2016 5:16 AM > To: [email protected]; [email protected]; > [email protected] > Cc: [email protected] > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > > This is contradictory to everything they stated in both the power point and > the Q&A. > > From the Q&A: > Question 61: If lactate is >4 and no crystalloid fluids are administered, do > you answer ?Yes? or ?No? for Septic Shock present? > Answer 61: The Septic Shock Present data element's Notes for Abstraction > indicates that if crystalloid fluids were not administered after the > presentation date and time of severe sepsis, to choose Value "2 (No)." > > Question 145: If initial lactate is >4, but no crystalloid fluids are given > during the 6 hours after severe sepsis, do we answer "No" to septic shock? > Answer 145: Not necessarily. You would select "No" for Septic Shock Present > if no crystalloid fluids were given at all after presentation of severe > sepsis. There is no time frame after severe sepsis presentation associated > with this. If fluids were not given within 6 hours following presentation of > severe sepsis but were given after 6 hours, then you would select "Yes." This > is an all-or-none point for crystalloid fluids. > > Question 172: If the patient has severe sepsis and an initial lactate of 4.5 > but does not receive any crystalloid fluids, would it still be "No" to Septic > Shock Present due to not having any crystalloids given? > Answer 172: Correct. > > This was from the transcript of the CMS presentation on October 26 (page 27): > Now please note, in the septic shock present data element, there is a bullet > point in the note for abstraction indicating that if crystalloid fluids were > not administered after severe sepsis presentation date and time, that you > would select allowable value 2 for septic shock present, which is equivalent > to No. For purposes of SEP-1 measure, at this point in time, regardless of > how septic shock is identified, if no crystalloid fluids were given after > severe sepsis presentation, you will select allowable value 2, which is No, > for septic shock present. > > Karen Belfi, RN, MSN > Quality Outcomes Coordinator > Lankenau Medical Center > 484-476-8092 > Pager: 5240 > > > > -----Original Message----- > From: [email protected] > [mailto:[email protected]] > Sent: Thursday, January 28, 2016 4:04 PM > To: [email protected]; [email protected]; Belfi, Karen > Cc: [email protected] > Subject: RE: [Sepsis Groups] Septic Shock Presentation Time > > I sent the question regarding fluids and septic shock presentation to CMS and > this is the response I received in November: > > Gena, > There are three ways to determine if Septic Shock is present. > 1. Severe Sepsis present AND Hypotension persists in the hour after > crystalloid fluid administration 2. Severe Sepsis present AND Initial > Lactate level >= 4mmol/L 3. Physician documentation of septic shock > > For #2 - Crystalloid fluid administration is not required to determine > whether the patient has septic shock if using the presence of severe sepsis > and the lactate level to determine. > > > Thanks, > Gena Henriques, MSN, RN > Quality Review Coordinator - Sepsis > Tulane Medical Center > 1415 Tulane Ave. > New Orleans, LA 70112 > Phone: 504-988-3195 > > Think Sepsis: Save A Life > This email and any files transmitted with it may contain PRIVILEGED or > CONFIDENTIAL information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error and > that any use, dissemination, distribution, forwarding, printing, or copying > of this email or any attached files is strictly prohibited. If you have > received this email in error, please immediately purge it and all attachments > and notify the sender by reply email or contact the sender at the number > listed. > > > > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Cobb, Amy L. > Sent: Thursday, January 28, 2016 5:45 AM > To: Townsend, Sean, M.D.; Belfi, Karen > Cc: [email protected] > Subject: [EXTERNAL] Re: [Sepsis Groups] Septic Shock Presentation Time > > Has something changed in the Spec Manual since the v5.0b came out? This is > copied and pasted from the manual: > > *If criteria for Septic Shock are not met, but there is physician/APN/PA > documentation of Septic Shock, choose Value ?1.? > > Allowable Values: > 1 (Yes) There is documentation of Septic Shock > 2 (No) There is no documentation of Septic Shock, or unable to determine > > Dr. Townsend, can you clarify this if physician documentation is not enough > and let us know if this was changed/updated? > > Thank you > > > Amy Cobb RN, BSN > Sepsis Coordinator > Research Outcomes > Morton Plant Hospital > MS #73 > 300 Pinellas St. > Clearwater, FL 33756 > 727-298-6953 (Desk) > 727-462-3638 (Fax) > [email protected] > > -----Original Message----- > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of Townsend, Sean, M.D. > Sent: Monday, January 25, 2016 4:12 PM > To: Belfi, Karen > Cc: [email protected] > Subject: Re: [Sepsis Groups] Septic Shock Presentation Time > > I don't see criteria met at 10:47. MD say so is not enough. > > > > On Jan 25, 2016, at 1:02 PM, Belfi, Karen > <[email protected]<mailto:[email protected]>> wrote: > > > > 10:47 would be septic shock time. It?s the earliest time criteria is met. > > > > Karen Belfi, RN, MSN > > Quality Outcomes Coordinator > > Lankenau Medical Center > > 484-476-8092 > > Pager: 5240 > > <image001.png> > > > > From: Sepsisgroups [mailto:[email protected]] On > Behalf Of [email protected]<mailto:[email protected]> > > Sent: Wednesday, January 20, 2016 9:15 PM > > To: > [email protected]<mailto:[email protected]> > > Subject: [Sepsis Groups] Septic Shock Presentation Time > > > > Clinical criteria for severe sepsis is met at 1002. Crystalloid bolus > completed at 1247. SBP=79 @ 1300. SBP=87 @1330. > > Initial lactic acid =4.0 resulted at 1126. > > ED physician note started at 1047 containing documentation of possible septic > shock. > > Would septic shock presentation time be 1047, 1126 or 1300? > > > > Karen King, RN MSN > > Quality Management Core Measures Specialist, Lead > > Lakeview Regional Medical Center > > 95 Judge Tanner Boulevard > > Covington, LA 70433 > > Office: (985) 867-4467 > > Cell: (985) 788-0585 > > Fax: (985) 867-4263 > > Email: [email protected]<mailto:[email protected]> > > > > This email and any files transmitted with it may contain privileged or > confidential information and may be read or used only by the intended > recipient. If you are not the intended recipient of the email or any of its > attachments, please be advised that you have received this email in error and > that any use, dissemination, distribution, forwarding, printing, or copying > of this email or any attached files is strictly prohibited. If you have > received this email in error, please immediately purge it and all attachments > and notify the sender by reply email or contact the sender at the number > listed. > > > > > > > > _______________________________________________ > > Sepsisgroups mailing list > > [email protected]<mailto:[email protected]> > > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=CwIGaQ&c=MS-5dKql6qjhmD6zBX8NdQ&r=KQhQAyB28wX0ryHeUUrvHwtJt_LBhCc_ENWLFE_5OQM&m=MIOxJC-J0Hl7V8zraHmRvAJqUnUQxV84ioAAkoOtpPQ&s=PE9haHZiSt0lsaWrtXo79byWSukDpnw1Pcj-cZckiGI&e= > > ---------------------------------------------------------------------- > Confidential: This electronic message and all contents contain information > from BayCare Health System which may be privileged, confidential or otherwise > protected from disclosure. The information is intended to be for the > addressee only. If you are not the addressee, any disclosure, copy, > distribution or use of the contents of this message is prohibited. If you > have received this electronic message in error, please notify the sender and > destroy the original message and all copies. > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > > ------------------------------ > > Subject: Digest Footer > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.sepsisgroups.org_listinfo.cgi_sepsisgroups-2Dsepsisgroups.org&d=AwICAg&c=PUnqOsCos0lYmbMtBbnNaXdHYubkuj3DpsbI90l9Eks&r=DABW1vPiprcyFbs5E3jbx_50WF6U5caTHUzeMSxN2vA&m=WnypchciFrfJKnHniacMFyYUygxSaSLbO559kZlPlNU&s=o4ktXtF-cEHXVoASG_H41FjK7IqYseaJD15FolqWaAI&e= > > > ------------------------------ > > End of Sepsisgroups Digest, Vol 190, Issue 4 > ******************************************** ---------------------------------------------------------------------- NOTICE: This email may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this email. If you are not an intended recipient of this email, you are hereby notified that any unauthorized use, dissemination or copying of this email or the information contained in it or attached to it is strictly prohibited. If you have received this email in error, please delete it and immediately notify the person named above by reply email. Thank you. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
