The interesting thing is that the original proposal was to delete these patients from your data, but based on Ron’s sleuthing, they may actually be a real part of the data. As a practical matter, it’s one of the last things docs will be thinking of in this situation.
Arguing for antibiotics in these cases at a minimum is not a bad idea. Sounds like all providers will be affected equally with this problem, so I’m not worried from a data perspective, but interesting effort to provide education around antibiotics in post-arrest situations. From: Cynthia Wells [mailto:[email protected]] Sent: Friday, May 19, 2017 7:04 AM To: Ron Elkin <[email protected]>; Townsend, Sean, M.D. <[email protected]> Cc: [email protected] Subject: RE: [Sepsis Groups] [**External**] Sepsis Alert Hello, I definitely agree.. In order to meet the sepsis bundle we would still need the other two criteria- suspicion of infection/SIRS, hence we should start abx earlier to if nothing else prevent progression if arrest not related to bacteremia. I am concerned about the fluids because most of these lactates are sky high they are automatically pulled into shock elements. Cindy Cynthia Wells Steward Health Care Director of Clinical Performance Analytics (508) 404-8647 From: Sepsisgroups [mailto:[email protected]] On Behalf Of Ron Elkin Sent: Thursday, May 18, 2017 10:43 PM To: Townsend, Sean, M.D. <[email protected]<mailto:[email protected]>> Cc: [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] [**External**] Sepsis Alert Attached is a study showing a 38% incidence of bacteremia in ED patients presenting with out of hospital cardiac arrest. It is often unclear if the bacteremia was a contributing cause, or a result of the arrest, but the study suggests we should have a low threshold for instituting immediate empirical antimicrobial therapy in these patients. Such patients will certainly complicate diagnosis, treatment, and outcomes if included in analysis of severe sepsis or septic shock unassociated with arrest. Ron Elkin MD San Francisco On Wed, May 17, 2017 at 10:56 AM, Townsend, Sean, M.D. <[email protected]<mailto:[email protected]>> wrote: 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]<mailto:[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<tel:%28925%29%20674-2045> Cell (925) 451-8792<tel:%28925%29%20451-8792> Fax (925) 674-2373<tel:%28925%29%20674-2373> [email protected]<mailto:[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]<mailto:[email protected]>] On Behalf Of Gwen S. Schneider Sent: Saturday, May 13, 2017 10:20 AM To: Townsend, Sean, M.D. <[email protected]<mailto:[email protected]>>; Parker, Erin <[email protected]<mailto:[email protected]>> Cc: [email protected]<mailto:[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]<mailto:[email protected]>] On Behalf Of Townsend, Sean, M.D. [[email protected]<mailto:[email protected]>] Sent: Thursday, May 11, 2017 9:36 PM To: Parker, Erin Cc: [email protected]<mailto:[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]><mailto:[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. Would any one like to share EHR sepsis alert criteria, and also be willing to share how it is working? 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