Joe,
Thank you for sharing your thoughts and suggestions regarding this article.
I've spent time reading through this and I too agree but in the same breath am
questioning exactly how institutions large and small will wrap their heads
around this massive endeavor....
The new tool qSOFA is intriguing but I have a questions. The assessment...The
new suggested definitions leave out lactic acid in the beginning and have the
providers using clinical assessments (ie. change in mental status, b/p and
respiration parameters).. I get that but that then pulls in almost anyone
walking through the ERs'. With the sheer numbers of folks seen and the
numerous providers coming in and out of our settings.. Many at my large
hospital are still working hard to grasp the current protocol bundle. Each are
trying to work smarter not harder..to be effective in early recognition and
apply appropriate treatment of early warning signs of sepsis.
Also, as you mentioned the billing and coding people..how would this be
implemented going forward...also under coding and reimbursement rates ..we
could go on and on.... I'm not so sure.
Is there clarification coming that will "exclude ESRD patients and /or CHF
patients? These 2 groups bring with them a multitude of concerns as far as
sepsis, fluids and how they are cared for in the setting of Sepsis protocols.
These I have heard over and over again in meetings, email and through the
sepsis web site..yet no answers.
Very much appreciate your thoughts.
Lynne
Lynne Jones RN, B.S., ONC
Clinical Practice/Analysis
Jacobsen Hall
Syracuse, NY 13210
(315)-464-4036
[email protected]
>>> "Clement, Joseph (DPH)" <[email protected]> 2/25/2016 8:46 PM >>>
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
SCCM | Sepsis Definitions
www.sccm.org
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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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