Troy, You ask the $64 million question. In-hospital patients are assessed with a different metric than emergency department sepsis patients. In hospital uses time of recognition, and for emergency department patients it is triage time.
The reasons for this can only be that triage time is easy to capture compared to time of recognition. However, the patient that presents with a normal lactate and normal blood pressure with pneumonia who crashes 8 hours after their arrival to the department and now meets severe sepsis criteria, is going to miss every treatment metric because their Time 0 is 8 hours prior. Triage time is not physiologic, and the policy requiring triage time as time zero is obviously not based on clinical data given the above example. Despite arguments against this presented in a unified voice from ACEP and SAEM, who represent all emergency physicians in the US, triage time has remained the time 0 for emergency department sepsis patients. If you can imagine applying this logic to in-hospital patients, then a patient who develops severe sepsis on day 3 of admission should then use their admission time 3 days prior as Time 0. Ryan Arnold, M.D. Clinical Investigator, Value Institute Department of Emergency Medicine Christiana Care Health System Newark, DE Sent from my iPhone On Sep 18, 2014, at 4:24 PM, Troy Marion <[email protected]<mailto:[email protected]>> wrote: Severe Sepsis group, I have an abstraction question. If a patient initially does not present as a Severe Sepsis upon arrival to the ED, but hours later meets the SIRS criteria, do you count the start time for the 3 hour bundle as: 1. Time of arrival or 2. Time pt presented with symptoms - Time of presentation (TOP) Thank you, Troy Troy Marion RN MSN CPHQ Manager Clinical Analytics Performance Improvement Department 215-612-2682 [email protected]<mailto:[email protected]> fax 215-612-4463 _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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