I believe SSC defines Time Zero as "triage time" for ED patients and "time
of diagnosis" for patients elsewhere in the hospital.
In support of ED triage time, one would argue that it is a simple, easily
determined time in all hospitals and avoids the inevitable endless,debate
about the accuracy of time of diagnosis. The counter-argument has been
that this definition will not account for and will unduly penalize those
confronting patients with true delays in development of the syndrome after
arrival in ED. The clarity of triage time has prevailed as the standard.
The expectation is that both iatrogenic and true delays in diagnosis will
haunt us all and the closer we can push initiation of treatment to the
indisputable time of triage, the better the outcome expected at each center.
>From a quality improvement perspective, however, it seems unreasonable to
expect caregivers to act appropriately before arriving at a working
diagnosis of severe sepsis or septic shock. For this reason, our center
chose to examine two questions, each with different implications for
improving performance:
1) Did the working diagnosis trigger appropriate and timely therapy? If
not, specific protocol, personnel, and systems issues must be examined and
corrected.
2) Was the working diagnosis timely,or was it delayed due to
nurse/physician/systems error? If delayed, distinctly different issues must
be examined. A delayed diagnosis may fall into 3 categories:
i) Potential delay - example: someone with SIRS and a potential
source of infection with delayed testing for later-documented organ
dysfunction.
ii) Real delay - example: organ dysfunction was timely documented
but not recognized as severe sepsis.
iii) Both i and ii.
.
I can't recall literature addressing this, but we estimate delay in
diagnosis in roughly 20% of our patients due to error. The analysis has
helped us better categorize and address our problems.
On a different note, it is well established that about 15% of patients with
severe sepsis or septic shock lack 2 or more signs of SIRS. These are
largely elderly and/or immunosuppressed patients. SIRS remains an important
screening tool, but when absent, severe sepsis must still be considered a
potential cause of unexplained organ dysfunction - in apparent
contradiction of consensus definitions.
My $0.02
Ron Elkin MD
California Pacific Medical Center
San Francisco, CA
:
On Wed, Feb 6, 2013 at 12:34 PM, Crittenden, Andrea L <
[email protected]> wrote:
> We use ICD-9 codes Severe Sepsis 995.92 or Septic Shock 785.52.****
>
> ** **
>
> Andrea Crittenden, RN****
>
> Quality Improvement Specialist****
>
> Providence St. Peter Hospital- Olympia, WA****
>
> 360-486-6465****
>
> ** **
>
> *From:* [email protected] [mailto:
> [email protected]] *On Behalf Of *Hunter,
> Patricia
> *Sent:* Wednesday, February 06, 2013 9:33 AM
> *To:* Taylor, Barbara A; Ron Daniels
> *Cc:* [email protected]
>
> *Subject:* Re: [Sepsis Groups] Time Zero****
>
> ** **
>
> Our Hospital currently performs Sepsis audits on ED and IP. We are
> relying on clinical personnel to capture sepsis patients for the audit.
> There is much discussion about moving the audit to more retroactive and
> pulling those patients with codes specific to Sepsis. Is anyone doing
> auditing relying on coding solely? ****
>
> If so, what ICD9 Codes are you using to pull data?****
>
> ** **
>
> Thanks,****
>
> Pat****
>
> ** **
>
> ** **
>
> Patricia Hunter, RN****
>
> Clinical Data Analyst****
>
> Performance Excellence****
>
> Mercy Medical Center - Des Moines, Iowa****
>
> 515-643-2206****
>
> ** **
>
> *"Life is not about waiting for the storms to pass...
> it's about learning to dance in the rain!"*****
>
> ** **
>
> ** **
>
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