New sepsis criteria?? Say what?

Rhonda sent me this information and I asked her if I could put this out for discussion. Anyone else looking into this? Thoughts?


I am not sure everyone is aware but this will drastically impact CDI, Coding and reimbursement. Do you plan to change your criteria / clinical indicators?

http://www.esicm.org/news-article/Sepsis-3-International-Consensus-definitions-Sepsis-Septic-Shock-Feb-2016
http://jama.jamanetwork.com

Key points:

• Sepsis is now defined as a ‘life-threatening organ dysfunction due to a dysregulated host response to infection’
• The key element of sepsis-induced organ dysfunction is defined by ‘an acute change in total SOFA score ≥ 2 points consequent to infection, reflecting an overall mortality rate of approximately 10%’.
• A simple bedside score (‘qSOFA’, for quick SOFA) has been proposed, which incorporates hypotension (systolic blood pressure ≤100mmHg), altered mental status and tachypnea (respiratory rate > 22/min): the presence of at least two of these criteria strongly predicts the likelihood of poor outcome in out-of-ICU patients with clinical suspicion of sepsis.
• Septic shock is now defined as a ‘subset of sepsis where underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality’. Clinical criteria identifying such condition include the need for vasopressors to obtain a MAP≥ 65mmHg and an increase in lactate concentration > 2 mmol/L, despite adequate fluid resuscitation.
• Given the urgent need to widely spread education campaigns and better inform the public about the clinical and economic implications of such condition, a lay definition of sepsis as ‘a life-threatening condition that arises when the body’s response to infection injures its own tissue’ has been also endorsed.

In essence, SIRS in the concept of infection is now dead. One has to meet criteria for severe sepsis now to have sepsis. I am not sure how this will impact the new Core Measure for Severe Sepsis.

I am doing some research on this but wanted to reach out to you to hear your thoughts and opinions.

Thanks in advance for your feedback. Enjoy your day.


Sincerely,

Rhonda West-Haynes, MHA, BSN, RHIA, CCDS, CCS Manager Clinical Documentation Specialists Chester County Hospital
Tel: 610-738-2428 | Cell: 484-401-4669 | Fax: 610-732-6811 Please update your contact list with my NEW email address:
Email: rhonda.west-haynes@uphs.upenn.edu
[1]


Comments

  • Yep... Just saw this Monday. Some of our docs here at UPMC were involved in this new clinical definition / criteria. Not sure what I think about it yet. Here is a link we got to a quick explanation of the qSOFA tool. I am responsible for developing some education for our CDI / Coders on this new criteria so I am sure I will have some input / opinions soon.

    http://qsofa.org/
    LeeAnn Conaway, RN, CCRN, CCDS
    Supervisor CDI/Coding, UPMC
  • In a nutshell, the medical staff at my institution have chosen not to implement or use these guidelines, and I have summarized the reasons below. I thought it might be pertinent to send this to all of you. There are other reasons cited, but two prominent concerns noted are:

    1) SEP-1, the new sepsis core measure in the United States does not rely on these new definitions and will not be updated to incorporate the changes proposed. A change to SEP-1 that was not field tested would adversely affect 5000 acute care hospitals in the United States gather information under SEP-1 to improve patient care.

    2) The new definitions and screening strategies derived from them have not been field tested.

    I hope this is useful.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421
  • Medical Staff is free to use and adopt any definition that they chose - the fact that this paper has been issued does not mean that the criteria will be endorsed by all clinicians, nor that the criteria may or may not be cited and used by CDI in a query function. Nor does anything stated in this article indicate that coding rules will, or should be, modified.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421




  • edited May 2016
    LeeAnn-the following link does not seem to work, was unable to search the site either could you resend me the correct link to the article I would like to read it. Thanks

    http://www.esicm.org/news-article/Sepsis-3-International-Consensus-definitions-Sepsis-Septic-Shock-Feb-2016

    Julie Draper
    Interim Coding & CDI Supervisor
    641.428.7032
    draperj@mercyhealth.com

  • edited May 2016
    This link does not seem to work. http://www.esicm.org/news-article/Sepsis-3-International-Consensus-definitions-Sepsis-Septic-Shock-Feb-2016
    Can you check to see if it is correct?

    Thank

Sign In or Register to comment.