Severe Sepsis patients in our organization go to our ICU step-down. They receive antibiotic, BLC and serial lactate monitoring to assess for progression to cryptic shock and monitor the bp trend. If the lactate rises to > 4 or bp drops they administer the fluid load and transfer to the ICU. All patients with lactate > 4 or hypotension after initial bolus go to the ICU. We have good outcomes with this model. We do not allow severe sepsis to go the med-surg or med-surg tele because they are not as familiar with the protocol and monitoring piece. We have control in the ICU step-down unit where the monitoring of vs and labs is more frequent.
Patty Patty Cormack RN, MSN Critical Care Clinical Educator Sepsis Coordinator Cardiovascular Coordinator Vanguard West Suburban Medical Center P 708-763-6662 Pager 630-255-6049 [email protected] -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Townsend, Sean, M.D. Sent: Friday, March 15, 2013 1:32 AM 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 This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of West Suburban Medical Center. This footer also confirms that this email message has been scanned for the presence of computer viruses. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
