I am talking sepsis only William E. Haik, M.D., F.C.C.P., C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110 Cell: (850) 803-5854 Fax: (850) 864-4438
> On Jan 17, 2015, at 5:05 PM, Terry Clemmer <[email protected]> wrote: > > Let's not confuse sepsis and severe sepsis. Severe sepsis requires an organ > failure that indicates the systemic inflammatory response is damaging organs > this is the group with higher mortality. Others may qualify to be discharged > > Sent from my iPhone > > On Jan 17, 2015, at 15:13, "[email protected]" <[email protected]> wrote: > >> This is what I am been predicting! >> >> I have spoke directly with Dr Levy on several occasions and he maintains >> if you have TWO sustained abnormalities of the SIRS criteria and not due >> to a non- inflammatory condition then he and the literature states that is >> sepsis... and this should stand with external reviewers. >> >> However, as a clinician I have trouble with this and I am sure I have a lot >> of patients with acute infective bronchitis who meet the criteria for >> sepsis in my office that I send home on antibiotics...Hardly are they septic! >> >> So at least make sure that the SIRS criteria are sustained till treatment >> is begun and not just a triage VS done in the ER. I also (unlike Dr Levy's >> advice) don't count an increased heart rate or RR in patients who are >> hypoxic, as in pneumonia. >> Good luck! >> >> >> >> William E. Haik, M.D., F.C.C.P., C.D.I.P. >> AHIMA Approved ICD-10-CM/PCS Trainer >> Office: (850) 863-2110 >> Cell: (850) 803-5854 >> Fax: (850) 864-4438 >> >> In a message dated 1/17/2015 9:45:57 A.M. Central Standard Time, >> [email protected] writes: >> I am writing to inquire how other institutions are handling or if you are >> even encountering concerns, that we are “over-calling” early sepsis, >> especially when the only SIRS criteria are tachycardia and tachypnea >> (sometimes only a single set of VS). We are reviewing all short stay >> (Observation, 1-2 day stays) and see “septic” patients who are “in no acute >> distress”, are only here in Observation status and never Inpatient, or stay >> as IP only 1-2 days, are not sent home on any antibiotics or only a short >> course of oral antibiotics. >> >> >> >> Often their only SIRS criteria are tachycardia and tachypnea—which are quite >> non-specific markers that can be seen with anxiety, pain, etc. but when >> paired with a suspected or documented infection role up to Sepsis?! >> >> >> >> Since Sepsis is a high-paying condition it’s also a high audit DRG (mainly >> because, in the past, many patients were in ICU, very ill, and expending >> lots of resources). Now that “early sepsis” is being diagnosed quite >> frequently, external auditors are reviewing sepsis DRG charts, and disagree >> that sepsis was present at all, recode the chart, reassign the DRG and >> reduce payment to UTI, pneumonia, etc. This is so frustrating as we are >> trying to educated our providers and nurses on the importance of having a >> high suspicion for sepsis and early recognition and now are turning around >> and saying don’t say ‘Sepsis’ unless they are “sick” because we need to be >> able to defend it!? L >> >> >> >> Any feedback, thoughts, or tools on how other institutions are handling >> this, would be greatly appreciated especially when it comes to the SIRS >> criteria which most of our clinicians call “soft criteria”? >> >> >> >> Thank you in advance for your time and expertise! >> >> Claudia >> >> Claudia Orth BSN, RN, CCRN-K >> >> Regional Sepsis Coordinator >> >> Munson Medical Center >> >> (231) 935-5692 (Voice) >> >> [email protected] >> >> >> >> >> >> _______________________________________________ >> 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
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