I have seen similar clinical scenarios as well. Also, I would highly propose to CMS to include physician documentation in the future guidelines. If the physicians document 'acceptable reasons' for not following a certain sepsis protocol/guideline, there should be a way to exclude the case from Sep-1 measure. Especially reasons for not administering the right amount of fluid at the correct rate for initial hypotension.
Thank you, Roopa Dhillon MBBS, MBA Clinical Quality Analyst I Quality Improvement/Clinical Outcomes University Hospitals Elyria Medical Centre 630 East River Elyria, Ohio 44035 T 440-329-4959 F 440-329-5971 Roopinder.Dhillon@UHhospitals .org Quality Assurance/Peer Review Privileged Pursuant to Ohio Rev. Code secs. 2305.24, 2305.25, 2305.251, 2305.252 and 2305.253 -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Thursday, May 18, 2017 3:57 PM To: [email protected]; [email protected] Cc: [email protected] Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert I have had this occur as well. Maggie Macias, RN Sepsis Program Coordinator Valley Regional Medical Center Brownsville, TX (956) 350-7179 (O) [email protected] -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Wednesday, May 17, 2017 12:57 PM To: Mary Draper <[email protected]> Cc: [email protected] Subject: [EXTERNAL] Re: [Sepsis Groups] [**External**] Sepsis Alert I would agree this is a confounder. You could delete from your local focus study, but they will still hit the metric for purposes of SEP-1. I'm not sure how often you see this to justify a change to SEP-1, but if common I'd take a look. On May 17, 2017, at 10:52 AM, Mary Draper <[email protected]> wrote: Hi Dr. Townsend, I have been looking through the Severe Sepsis guidelines with regards to patient who present in cardiac arrest to the ED. I have not found any information specific to this issue. Most of them have an elevated lactate. It is difficult to determine what was the cause of the arrest. We are proposing to our Sepsis committee that we delete these patients from the focus study. What are your thoughts on this subject? Thanks Mary Draper RN BSN Coordinator Quality Improvement Peer Review Support CV/CT Quality Management JMH Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected] "O, let us always have a mountain within our soul, with a peak so high that we never quite reach the top... For then we will always strive for greater things and will not be content with merely climbing hills." Ardath Rodale -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of Gwen S. Schneider Sent: Saturday, May 13, 2017 10:20 AM To: Townsend, Sean, M.D. <[email protected]>; Parker, Erin <[email protected]> Cc: [email protected] Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Hello, I am interested in the responses you might receive from your question. We use EPIC, and we have for LA a value of >2.0 a call from lab as a critical. I am wondering if other hospitals are doing the same. And what does MS have to say about it? Sierra Schneider Salem Oregon ________________________________________ From: Sepsisgroups [[email protected]] On Behalf Of Townsend, Sean, M.D. [[email protected]] Sent: Thursday, May 11, 2017 9:36 PM To: Parker, Erin Cc: [email protected] Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Erin, I'm sorry you received an inflammatory and obtuse response to your question. Such posts have earned the name "troll" or having been "trolled" for for a reason. Maybe to get a real answer to your question, you could share with us which EHR you use? Sean On May 5, 2017, at 7:05 AM, Parker, Erin <[email protected]<mailto:[email protected]>> wrote: 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. 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