Sean, Although I believe you know the answer that comes from Sutter Health - Sacramento Sierra Region from our data that you have seen, the answer to your question is, IMHO, fairly pragmatic. In our larger (community) hospitals, as many severe sepsis patients as possible go directly from ED to the ICU (2/3 - 3/4) and in those institutions our mortality rates are significantly improved. But our smaller hospitals, where the ICU bed capacity is 6-8, the majority of severe sepsis patients are admitted to med- surg with attendant higher mortality rates. (with one notable exception in Amador where a small hospital with an 6 bed ICU admits severe sepsis patients to the unit more frequently again with an attendant lower mortality rate)
Thanks, Mary Ann Daly, RN BSN CCRN DC Regional Clinical Initiative Lead-Sepsis and ICU Liberation (ABCDE) Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: [email protected] Blackberry: 916.200.5604 Office: 916.614.6370 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 -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Thursday, March 14, 2013 11:32 PM To: '[email protected]' Subject: [Sepsis Groups] Where Does Severe Sepsis Belong? It's been a long time since I've had to ask this question. I used to think I knew the answer. Here it is: do all patients who meet severe sepsis criteria need to be admitted to the ICU ? Examples: 1. Pneumonia, fever, tachycardia, INR 1.5. 2. Cellulitis, leukocytosis, fever, creatinine 2.0. 3. UTI, leukocytosis, fever, lactate 3.0. Where do people put these patients in reality? What mind of monitoring do they deserve? By prevailing bundles, each gets lactate checked, blood cultures, broad spectrum antibiotics. That's it. Good enough? Good enough for the floor? Need the ICU? Why? Sean Sean R. Townsend, M.D. Vice President of Quality & Safety California Pacific Medical Center 2330 Clay Street, #301 San Francisco, CA 94115 email [email protected] office (415) 600-5770 fax (415) 600-1541 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
