Thank you I can only hope that they tighten the definition requiring more elements to define sepsis and exclude certain conditions that may mimic sirs such as pneumonia with hypoxia resulting in increased pulse and respiratory rate.
Mitchell thank you for your selfless work in this area And thank you for keeping us all in the loop 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 18, 2015, at 2:26 PM, Mitchell Levy <[email protected]> wrote: > > By the current definition, sepsis is defined at 2/4 SIRS + documented or > suspected infection. So yes, even mild bronchitis by that definition is > “sepsis.” Most clinicians use “sepsis” as synomous with Severe Sepsis, > which includes organ dysfunction. > > Having said that, there is a task force that has been re-visiting the > definitions of sepsis. We have been meeting for the past year, and the > results will be presented today at SCCM meeting in Phoenix. Stay tuned….. > > > Mitchell > > From: <[email protected]> > Date: Saturday, January 17, 2015 at 12:16 PM > To: <[email protected]>, "[email protected]" > <[email protected]> > Subject: Re: [Sepsis Groups] SIRS/Sepsis Criteria and Coding > > 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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