Hello,
I'm very interested in hearing what people are thinking about the newly released definitions of Sepsis and Septic shock: http://www.sccm.org/Research/Quality/Pages/Sepsis-Definitions.aspx [http://www.sccm.org/images/SCCM_logo.jpg]<http://www.sccm.org/Research/Quality/Pages/Sepsis-Definitions.aspx> SCCM | Sepsis Definitions<http://www.sccm.org/Research/Quality/Pages/Sepsis-Definitions.aspx> www.sccm.org About SCCM. Join; Governance; Leadership and Staff. President; Council ; Past Presidents; CEO; Staff; SCCM Careers; Support SCCM; Collaborations; Industry Partnerships We are busy trying to digest this information and catalog the potential impacts/ramifications. I'm sure many are doing the same. What do people think? Here are some of my early thoughts/concerns: [] Should we replace our current SIRS + Infection screening tools (imperfect as we've known them to be) in favor of just using infection + qSOFA? Would that mean a slower response for many patients? Would that be appropriate or not? [] Should we train medical teams and/or RNs to use the SOFA tool? That would necessitate a lot of additional ABGs and is unfamiliar to many providers. [] Will the failure of elevated lactate to "count" as an organ dysfunction qualifying for the sepsis diagnosis lead to a de-emphasis of lactate measurement? Will people use it less? On the other hand - this is more aligned with ICD-10. [] The new definition for sepsis is very different than the definition of severe sepsis used in the SEP-1 measure - so should we continue to teach people to apply the bundle to a broader range of patients? If we did, that would mean we teach people to apply the sepsis bundle to patients that don't have "Sepsis". [] There will be a gap between the Sepsis-3 definition and the ICD-10 codes, that could result in under-coding (e.g. patient with SIRS and PNA does not get the ICD-10 code for sepsis). This would adjust our risk adjustment measures, reimbursement rates, etc. [] On the positive side, does this present an opportunity to zero in our interventions on the (smaller) subset of patients who are most likely to benefit? Could that drive acceptance of the full bundle? I could probably go on. Apologies for the long post but I'm hoping to start what I'm sure will be a very long series of conversations. Thank you! Joe Joseph Clement, MS, RN, CCNS Clinical Nurse Specialist San Francisco General Hospital ph: 415206-6174 pg: 415 327-0220
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