My issues w the new definition are 1. While it is more specific it is less sensitive and leave a population w mortality up to 10% out. Keep in mind that acute MI has less than 5% mortality 2. Sepsis has a spectrum of presentation and course and the new definition only are looking at the sickest. Our 11 yrs experience in decreasing mortality had the most gain on the medium to less sick where as those who are i shock and intubated for >96 hrs have has less success in consistently keeping mortality and cost down. I think concentration on the new definition gies against what we have been trying to achieve in earlier recognition and treatment. 3. Lactate in this new definition ia confusing at best. They don't want to included as part of "sepsis" but use it in septic shock. 4. Coding- this will mess it up beyond repair 5. SEP 1 and new definition and ICD 10 and SSC and current protocol is a recipe for confusion and disastrous distraction 6. All of the studies proving mortality benefit came from Sirs criteria definition for inclusion. 7. Lots of ABG will be added as part of SOFA.
What we are planning to do is retrospectively run cases vs new definition to see. Why release a new definition but not new evidence on how adding the is definition will lead to better outcomes or cost. I was there at SCCM and had a chance to speak w one of the member of the committee that wrote the changes. They admit that the new definition is not the end definition and that they hope to change the definition again in a few years as the pathology is better understood. There needs to be better coordination between cms, clinical side of medicine. This is an example of how not to do it. Andre Vovan MD MBA On Mar 9, 2016 2:00 PM, "Lynne M Jones" <[email protected]> wrote: > 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 > <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 > > Please note that the information contained in this message and any files > transmitted with it are privileged and confidential and are protected from > disclosure under the law, including the Health Insurance Portability and > Accountability Act (HIPAA). If the reader of this message is not the > intended recipient, or an employee or agent responsible for delivering this > message to the intended recipient, you are hereby notified that any > dissemination, distribution or copying of this communication is strictly > prohibited and may subject you to criminal or civil penalties. If you have > received this communication in error, please notify the sender by replying > to the message and delete the material from any computer. Thank you, Hoag > Memorial Hospital Presbyterian and its Affiliates > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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