Bacteremia

srecor@cvph.org

Hi, My name is Steve.

Would you query a physician for sepsis when a patient has bacteremia and no clinical signs of sepsis?  My manager is asking us to and I disagree. Just wondering what others do in this situation.

Thank you! 

jackietouch@aol.com

No~ unless the indicators for sepsis are present I feel to query for sepsis would be introducing information into the record.

Jackie Touch

kbalogun

Unless you give us a full presentation of the case, its difficult to offer an opinion. Maybe your boss is right and you just might not be as knowledgeable as your boss . . . we don't know.

I do not want to believe that your manager is stupid to the extent of asking you to do what is blatantly unethical!

I have seen lots of sub-par CDI managers/coordinators/directors . . .  but they are not usually DELIBERATELY fraudulent or unethical.  Well, unless you work at Prime Healthcare.

jmccorkl@stanfordhealthcare.org

I would not query if clinical indicators are absent.  When the provider has been clear in documenting 'Bacteremia' there is no further clarification needed.

annnd2009@gmail.com

Assuming no antibiotic treatment? and no physical signs? with a positive culture?

snchan1819

We've told our CDI's and coders not to query for sepsis when "Bacteremia" has been documented but without clinical indicators of sepsis.  However, in some circumstances, you may need to query for underlying etiology of bacteremia as it is a symptom code and shouldn't be assigned as Pdx, but that's not what this question is about anyway.

proddy@clarionhospital.org

I have a case where the pt definitely meets old Sepsis criteria with temp 105.0, wbc 14.8, HR 100, Resp rate 22, urine cultures + staph aureas.  No organ failure though.  Er called it Sepsis, attending says Bacteremia.  Under Sepsis 3  criteria, the attending is correct however it is hard to imagine a temp that high and not have a Sepsis drg

morris-jeff@CooperHealth.edu

proddy-Has your organization adopted the Sepsis 3 definitions?

proddy@clarionhospital.org

we are in process (some of my doctors aren't there yet) and I am trying to not query for it if there isn't Sepsis 3 criteria present.  This particular attending is starting to use Sepsis 3 criteria.  We have had a few denials recently for using Sepsis without Sepsis 3 criteria

morris-jeff@CooperHealth.edu

We are in the same spot--several denials based on Sepsis 3 guidelines but Organization has not adoped the definition. Some attendings have adopted it and are teaching the residents this way. Would love to hear any tips you have!!

Jeff

proddy@clarionhospital.org

our hospital doesn't always seem to "adopt" anything as a whole but lets it up to the attendings to decide, however, I am trying to work on that.  We did work on Malnutrition and determined our process for using the Nutrition consult notes and she is doing some education with our residents and medical students.  I want to work with our nephrologist for CKD and AKI and try to get consistency there as well.  I haven't tackled Sepsis 3 yet but I'm sure it will need to follow soon.  I do an occasional Physician Newsletter and try to incorporate these types of changes in it, although I'm not sure how many of them read it?  Beyond that it is one on one opportunities as they come up and resident education.  I think that in teaching hospitals it is difficult because by the time you get them trained they leave and the next batch comes in!

morris-jeff@CooperHealth.edu

CDI in academic medical center = job security, lol!! How is the differing diagnostic criteria affecting Quality's Sepsis Core Measure?

proddy@clarionhospital.org

I'm not sure where we are at with that at this point?  QI had included me briefly but recently not so much.  We had an issue initially with the ER accurately diagnosing severe sepsis and getting the fluid boluses and lactic levels which I think has gotten better from my review of it

proddy@clarionhospital.org

So, now I have a case that is a managed care that truly denies Sepsis unless it meets Sep 3 criteria.  this pt does not meet, currently diagnosis of bacteremia with + blood culture for e coli.  Dr said in one of his notes, no evidence of Septicemia (he likes those old terms).  Anyways I really don't have a good primary diagnosis.  Any suggestions?  The only other thing she had was an enlarged uterus and they did a hysteroscopy during the stay-- UR will love that.  

proddy@clarionhospital.org

Not to keep bringing the same issues to the table, but when I was trained in CDI, the consultant was very adamant that Bacteremia was not to be used anymore, it needed to be queried for Sepsis.  With "old criteria" that was seldom an issue.  We have recently decided to adopt Sepsis 3 criteria for query and/or sepsis validation if needed.  I have had at least 3 cases since then that have had positive blood cultures, but did not meet the SOFA criteria.  How do some of you guys handle this?  Do you query for Sepsis?  

morris-jeff@CooperHealth.edu

If the patient does not meet sepsis criteria, we do not query for sepsis. I feel that would be leading and asking the MD for a diagnosis that is not clinically supported. Many times, patients are treated for bacteremia and are not septic. You will see this in certain patient populations, especially those who are not symptomatic or are not exhibiting a systemic response.

Thanks,

Jeff

proddy@clarionhospital.org

That was my gut reaction also, and I have not queried for them, I guess I just needed validation that I was taking the right path...thanks Jeff!