So,Sutter-wide we use arrival time for ED patients regardless if first low bp is two hours later, or lactate comes back 1 hour later. It is not the most accurate method of determining time of septic shock onset/severe sepsis onset. But it was determined to be easy, standardized, less subjective and more likely already entered in database (therefore not requiring manual entry). That said, all facilities deal with the same start point. Unfortunately that means that the patient who is being boarded in your ED and develops Septic Shock or Severe Sepsis much later during stay will likely not meet time parameters for EGDT.
Those patients who develop Septic Shock or Severe Sepsis on the floor following admission have a time zero of arrival to ICU (again a challenging, not very accurate time stamp, but again, already a part of patient's electronic record, does not require manual entry and is not left to subjective interpretation). This may cause patients who are transferred to ICU to have appearance of having met time parameters for EGDT but likely to have poor outcome (as they dwindle on floor for a longer period of time). And despite these limitations, the scholarly articles by Dellinger, Levy, Townsend et al have shown a significant improvement in outcome in those facilities that initiate EGDT. So, not a perfect system, but if we are all standardized to this method with our data collection, we are likely to get a better sense of the true impact of EGDT. My two cents, Karin Molander MD Mills Peninsula Hospital Sutter Coastal On Tue, Jun 11, 2013 at 1:07 PM, Rohrbach, Dawn < [email protected]> wrote: > Can anyone tell us what you use to determine the time zero for your not > present on arrival severe sepsis patients? > > *Dawn Rohrbach RN/ CCRN* > *Assistant Clinical Manager ICU/ STAT RNS* > *Saint Patrick Hospital * > *500 West Broadway* > *Missoula , MT. 59802* > *[email protected]* > 406 329-2814 > *" The single most problem with communication is the illusion that it has > taken place"* > > > > * ________________________________ * > This message is intended for the sole use of the addressee, and may > contain information that is privileged, confidential and exempt from > disclosure under applicable law. If you are not the addressee you are > hereby notified that you may not use, copy, disclose, or distribute to > anyone the message or any information contained in the message. If you have > received this message in error, please immediately advise the sender by > reply email and delete this message. > > _______________________________________________ > 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
