Sean,
At our institution and I am sure at other hospitals a number of septic patients
are admitted to the floor and subsequently within 24hr are transferred to CC-
sicker and likely with longer LOS than if they had been initial monitored and
fluid resuscitated more closely in CC from the onset.
CC units in best practice hospital according to the APACHE III data base have
between 10 to 20 low risk monitor patients (i.e. are not actively receiving a
CC dependent intervention) but are At-Risk this I believe is appropriate
similar to negative lap rate for appendectomies so as to not miss any- as the
down side is great. If your institution has an experience different than above
then perhaps your may have too many low risk monitor patients in CC and could
benefit from a change in strategy .
Looking at our data however we are still admitting too many patents that would
benefit from intensive monitoring to the floors with delay in resuscitation and
its associated morbidity and mortality.
Your question I believe is where is the break point when a CC admission is not
need for a septic patient. In my opinion if you still meet sever sepsis
criteria after initial ED or floor resuscitation (1000cc of fluids and
antibiotics) you will likely benefit from CC. Moving a septic patient out of CC
after 6 or 12hr, if no longer, needed makes more sense than transferring to CC
after 6 or 12 hr of under resuscitation.
My thoughts, Frank.
Frank Sebat MD FCCM
Medical Director of RRS
Kaweah Delta Medical Center
Visalia
Sent: March 14, 2013 11:31 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
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