Hi Dr. Townsend, I completely understand now the CMS SEP-1 measure "shock clock" time zero starts when the you have tissue hypoperfusion, evidenced by either initial lactate > 4 or persistent hypotension in the hour after crystalloids fluids given. Am I the only one that was totally mixed up thinking the shock clock started with severe sepsis with hypotension or lactate greater than 4? I feel a little foolish as I posted a few things. I am now cleared up but just wondering if you can help explain if there was/is a difference at all with how the SSC did "shock clock time zero" and how CMS is doing shock clock time zero. Thank you so much for all your hard work! Jennifer Halligan, RN Quality Review Nurse San Joaquin General Hospital Tel: 209-468-7471 Fax: 209-468-7011
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