I try to give them as much time as possible so using the triage time buys them a few minutes as it is normally the first recognition as we have a screening built into our triage. If for some reason they are screened incorrectly, but the MD notes it then I use the time the md sees the patient as that is what they record. Hope this helps !
Abstraction notes: If severe sepsis is present on arrival to the Emergency Department or severe sepsis is identified in triage, the Severe Sepsis Presentation Time is the time the patient was triaged in the Emergency Department. If more than one triage time is documented (e.g., "Triage started" and "Triage completed") use the later time reflecting triage is completed. If a suspected infection, severe sepsis or septic shock is in an ED physician note without a specific time documented within the note use the time the note was started or opened. From: Bly, Lori [mailto:[email protected]] Sent: Thursday, January 26, 2017 6:51 AM To: 'Belfi, Karen'; Gibbs, Katie; 'Barnes-Daly, Mary Ann'; Crowley Amy; [email protected] Subject: RE: [Sepsis Groups] [**External**] Question for core measure I believe we use arrival time - Our arrival time is earlier than triage time Lori Bly, RN Quality Management Department ACMH Hospital One Nolte Drive Kittanning, PA 16201 Extension: 8459 email: [email protected]<mailto:[email protected]> Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Belfi, Karen Sent: Tuesday, January 24, 2017 2:34 PM To: Gibbs, Katie; 'Barnes-Daly, Mary Ann'; Crowley Amy; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] [**External**] Question for core measure I believe you would look for when the pt was admitted, which is later in the ED visit-when the order to admit is actually written (or whatever you use at your hospital). If it were documented as present on arrival, you would use the triage time. From: Gibbs, Katie [mailto:[email protected]] Sent: Tuesday, January 24, 2017 2:33 PM To: Belfi, Karen; 'Barnes-Daly, Mary Ann'; Crowley Amy; [email protected]<mailto:[email protected]> Subject: [EXTERNAL] RE: [Sepsis Groups] [**External**] Question for core measure Thank you for the clarification! Also, Looking at the Additional Notes for Abstraction 5.2a under Severe Sepsis Presentation date it states "For Physician/APN/PA documentation of severe sepsis indicating "present on admission" or "admitted with", use the date and time of admission to the hospital. If the patient is admitted through the ED, even if the provider indicated present on admission wouldn't the time be triage time???? From: Belfi, Karen [mailto:[email protected]] Sent: Tuesday, January 24, 2017 2:27 PM To: Gibbs, Katie; 'Barnes-Daly, Mary Ann'; Crowley Amy; [email protected]<mailto:[email protected]> Subject: RE: [Sepsis Groups] [**External**] Question for core measure That is correct, Katie. If the provider documents septic shock, they do not need to document severe sepsis. You would use septic shock time for both. And if the patient meets criteria, you don't need the provider to document it. From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gibbs, Katie Sent: Monday, January 23, 2017 9:47 AM To: 'Barnes-Daly, Mary Ann'; Crowley Amy; [email protected]<mailto:[email protected]> Subject: [EXTERNAL] Re: [Sepsis Groups] [**External**] Question for core measure I am sorry this still seems unclear to me. If the provider documents septic shock then obviously the patient has severe sepsis. Why would the provider need to document severe sepsis and septic shock? Also, from the description below, then if a patient meets all criteria for severe sepsis and the provider only documented sepsis then it should be answered no? From: Sepsisgroups [mailto:[email protected]] On Behalf Of Barnes-Daly, Mary Ann Sent: Saturday, January 14, 2017 1:24 PM To: Crowley Amy; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] [**External**] Question for core measure Yes Amy, you are correct - that means if what IS documented does not meet criteria, or if: 1. Nothing is documented - not done 2. Done but not documented - not done All = fallout Thanks, MARY ANN BARNES-DALY MS RN CCRN DC | Clinical Performance Improvement Consultant Quality & Clinical Effectiveness Team | Office of Patient Experience Sutter Health -2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| [email protected]<mailto:[email protected]> "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." ~R. Buckminster Fuller From: Sepsisgroups [mailto:[email protected]] On Behalf Of Crowley Amy Sent: Thursday, January 12, 2017 2:26 PM To: [email protected]<mailto:[email protected]> Subject: [**External**] [Sepsis Groups] Question for core measure WARNING: This email originated outside of the Sutter Health email system! DO NOT CLICK links if the sender is unknown and never provide your User ID or Password. I just abstracted a pt with this exact scenario. The wording below of "if criteria is not documented" confuses me. What if the criteria is not met AT ALL? Not documented or met? Is that not the same thing? The criteria being met within 6 hours is the ENTIRE premise for being able to say that the pt had severe sepsis, EVEN IF the provider documents septic shock when the pt doesn't really have it... Maybe I'm not thinking straight or I'm not getting something, but it doesn't make sense to me.. Thoughts? I am highlighting with green. I do not want to have to say yes to pt's such as these when the severe sepsis criteria was never met during the entire pt stay. The only thing they had was a source that grew out from an infected dialysis catheter. The pt was never on any pressors or had any organ dysfunction. Severe Sepsis Present Documentation of the presence of severe sepsis. Was severe sepsis present? Allowable Values 1 (Yes) Severe Sepsis was present. 2 (No) Severe Sepsis was not present, or Unable to Determine. One of the rules for abstraction: "If criteria for severe sepsis are not documented and there is not physician/APN/PA documentation of severe sepsis, but there is physician/APN/PA documentation of septic shock, choose Value "1." In addition: this is the criteria for septic shock: Septic Shock Present Documentation of the presence of septic shock. Is there documentation of the presence of septic shock? Allowable Values 1 (Yes) [cid:[email protected]]There is documentation of Septic Shock. 2 (No) There is no documentation of Septic Shock, or unable to determine. Notes for Abstraction * The criteria for determining that Septic Shock is present are as follows: ( Is it just the documentation of OR does a and b below have to be met??) * There must be documentation of severe sepsis present. ( my pt did not have the criteria met nor was severe sepsis documented) AND * Hypotension persists in the hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration<javascript:void(0);>, evidenced by * systolic blood pressure (SBP) < 90, or * mean arterial pressure < 65 or * a decrease in systolic blood pressure (SBP) by > 40 mmHg. Physician/APN/PA documentation must be present in the medical record indicating a >40 mmHg decrease in SBP has occurred and is related to infection, severe sepsis or septic shock and not other causes. OR Tissue hypoperfusion is present evidenced by * Initial Lactate level is >= 4 mmol/L My pt had documentation of septic shock, but no severe sepsis or any criteria for it, like I have said. In my opinion, these two rules for severe and shock are contradictory. Amy Crowley Sepsis Coordinator Medical City Denton 3535 South I-35E Denton, Texas 76210 P: 940-384-3254 C: 214-801-2950 DentonRegional.com 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.
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