I agree with Dena. Cholecystitis doesn’t generally give you a bili that high, and I would think of obstruction and cholangitis. Without that, sepsis would be next on my list. but I would query the doctor to better understand his/her clinical impression.
Greg Stanford, MD Medical Director Clinical Documentation Improvement and Outcomes 1840 Amherst Street | Winchester, Va 22601 Phone: (540) 596 4999 Cell: 540 664 5736 | |[email protected] <mailto:[email protected]> CONFIDENTIALITY NOTICE: This e-mail is confidential, may be legally privileged, and for the intended recipient only. Access, disclosure, copying, forwarding and distribution by any means is strictly prohibited. If received in error, do not read but delete and e-mail confirmation to the sender. > On Jul 5, 2016, at 8:12 AM, Dena Videtic <[email protected]> wrote: > > Sandra, > This is a good question. From an abstraction point of view, I would look for > physician documentation that the patient has Severe Sepsis because as nurses, > it is not in our scope of practice to diagnose patients. The bilirubin could > be elevated due to a biliary obstruction. An interesting article was > published in April about the subjectivity of sepsis diagnosis even among > physicians. If you’re interested it is called: ‘Diagnosing Sepsis is > Subjective and Highly Variable: A Survey of Intensivists Using Case > Vignettes” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822273/ > <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822273/> > > > Dena Videtic RN BSN > Quality Indicators > Doctors Hospital > Coral Gables, FL > 786-308-3315 > > From: Sepsisgroups [mailto:[email protected] > <mailto:[email protected]>] On Behalf Of Murray, > Sandra > Sent: Thursday, June 30, 2016 2:26 PM > To: [email protected] > <mailto:[email protected]> > Subject: [Sepsis Groups] Sepsis Question on organ dysfunction > > Would you count a t.bili of 9.3 as organ dysfunction if patient comes in with > abdominal pain, meets the SIRS criteria and the CT shows pt to have acute > cholecystitis? > > > Sandra Murray, RN, BSN | Heart Failure & Sepsis Program Coordinator > Performance Improvement-Patient Safety and Risk > T 817.848.4963 | M 682.367.3032 > [email protected] <mailto:[email protected]> > > <image001.png> > > Follow us on Social Media > > This document was generated by, or was prepared by or at the direction or > request of a medical committee, medical peer review committee, nursing peer > review committee, and/or patient safety committee, including a joint > committee, of Texas Health Resources and its member hospitals as defined > under Texas Health & Safety Code Sec. 161.031, et seq., Texas Occ. Code Secs. > 151.001, et seq., 160.001, et seq. and 303.001, et seq., and is used for > committee purposes, specifically, quality assurance and assessment and the > evaluation of patient safety and medical and healthcare services at the > Hospital. This document and the information contained within it are > considered confidential, privileged and not subject to court subpoena > pursuant to the above-cited statutes and 42 U.S.C. Sec. 11101, et seq. > > > The information contained in this message and any attachments is intended > only for the use of the individual or entity to which it is addressed, and > may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from > disclosure under applicable law. If you are not the intended recipient, you > are prohibited from copying, distributing, or using the information. Please > contact the sender immediately by return e-mail and delete the original > message from your system. > > This message originates from Baptist Health South Florida (BHSF). It contains > information that may be confidential or privileged and is intended only for > the individuals or entity named above. It is prohibited for anyone else to > disclose, copy, distribute or use the contents of this message. This message > may not be copied or distributed without this disclaimer. All personal > messages express views solely of the sender, which are not to be attributed > to BHSF. If you received this message in error, please notify us immediately > at [email protected] <mailto:[email protected]>. BHSF > scanned this email for viruses, vandals and malicious content > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > <mailto:[email protected]> > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > <http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org>
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