According to Sepsis-2 and Sepsis-3, sepsis comprises a patient who is sicker than the average patient with that underlying infection, with acute sepsis-related organ dysfunction. Negative blood cultures are not uncommon. I call sepsis "the condition formerly known as severe sepsis," and all sepsis patients now should be documented in a way that results in R65.2- and SEP-1 core measures should be attended to. One of the core measures is blood cultures. SO, yes, blood cultures SHOULD be done or the provider will fall out.
Would you query for sepsis when no blood cultures were drawn?
positive blood cultures do not constitute the diagnosis of sepsis. For quality measurements within a facility they will fall out of protocol, but if clinical indicators are present with an active infection it would be appropriate to query the physician
I am not talking about negative blood cultures. I am talking about cases where no blood cultures were ordered or drawn. It was not missed. MD did not document sepsis during inpt stay. A query was placed post DC for sepsis. Pt with UTI and 2 SIRS criteria. Most of not all patients with UTI will meet 2 SIRS criteria. Another for patient who was afebrile with 2 SIRS criteria and infection.
I guess you have to go back to your organization and team and have some discussions—what do your MD’s consider sepsis, are you using SEP2 or SEP3, etc.. how important are blood cultures in the diagnosis of sepsis when negative blood cultures do not preclude the diagnosis. Sure, patients with any localized infection may have SIRS and that’s probably why SEP3 has now been endorsed by the Surviving Sepsis Campaign. But...CDI is not part of the treatment team nor are we diagnosing Providers. So, it’s uo to the Provider if they consider the patient septic or not. Present them with the clinical indicators and let them decide.
I am pretty conservative with queries but i wouldnt let the fact that cultures were not drawn sway me from querying for sepsis if the patient meets criteria and received appropriate treatment.
If we start scrutinizing what was ordered or not ordered them I think we get way too far off in the weeds. Then you could plead the case for not querying for respiratory failure if the patient did not have ABG’s or were not on mechanical ventilation. Another example would be not querying for type of pneumonia based on antibiotic selection due to no sputum cultures being ordered. We already know that many times they grow normal oral flora or nothing but clinically the patient is exhibiting symptoms of a complex pneumonia.
I think every CDI program should have these discussions to determine thresholds for queries, etc..
I would not query for sepsis if there is no blood cultures drawn. True, you do not have to have positive BC to have sepsis, however, the physician must not be thinking sepsis since he/she did not follow the sepsis pathway and order BC. If a physician documents sepsis, with no BC, but has the clinical indicators of sepsis and systemic response i.e. metabolic encephalopathy or AKI I definitely would not Query for validation of Sepsis
In my opinion, whether blood cultures are drawn has no bearing on whether the patient clinically has sepsis and/or whether a query is needed. I understand the core measure issue but that is not relevant to the discussion of whether the patient truly had sepsis. Blood cultures are often missed on patients that meet sepsis criteria.
As to your scenario in which you are asking whether a patient with 2 SIRS criteria and underlying UTI should be queried for sepsis, I would recommend discussing this with a physician champion, liaison, or other resource to determine what sepsis criteria your facility supports. There is variability in the industry as to what criteria is being used.
Review of the 2016 Clinical practice brief on validation queries, list these options. My question is related to "sepsis not clinically significant". I don't get that option, clinically I can't come up with a time when the patient has sepsis and it is not clinically significant? I get it was ruled out, or it is present.. can somebody help me follow this viable option?
Agree that option is not logical, at all. Suggest you check the 2019 AHIMA Clinical Practice Validation update and view the sample queries and offered options. (I wrote the 3 sample queries in this update).
Comments
Is this an an isolated event that cultures weren’t drawn? Maybe they were missed?
I am pretty conservative with queries but i wouldnt let the fact that cultures were not drawn sway me from querying for sepsis if the patient meets criteria and received appropriate treatment.
If we start scrutinizing what was ordered or not ordered them I think we get way too far off in the weeds. Then you could plead the case for not querying for respiratory failure if the patient did not have ABG’s or were not on mechanical ventilation. Another example would be not querying for type of pneumonia based on antibiotic selection due to no sputum cultures being ordered. We already know that many times they grow normal oral flora or nothing but clinically the patient is exhibiting symptoms of a complex pneumonia.
I think every CDI program should have these discussions to determine thresholds for queries, etc..
Thanks,
jeff
In my opinion, whether blood cultures are drawn has no bearing on whether the patient clinically has sepsis and/or whether a query is needed. I understand the core measure issue but that is not relevant to the discussion of whether the patient truly had sepsis. Blood cultures are often missed on patients that meet sepsis criteria.
As to your scenario in which you are asking whether a patient with 2 SIRS criteria and underlying UTI should be queried for sepsis, I would recommend discussing this with a physician champion, liaison, or other resource to determine what sepsis criteria your facility supports. There is variability in the industry as to what criteria is being used.
Katy
Agree w/ Katy & Jeff, as stated, the core measure has no bearing as to whether or not sepsis may be present.
Paul
Interesting article in today's CDI Strategy email regarding the 1 hour bundle.
http://https//acdis.org/articles/news-hospitals-shouldn%E2%80%99t-implement-one-hour-sepsis-bundles-sccm-and-acep-say?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_190124_CDI_ECDIS%20(1)
Jeff
Paul Evans, RHIA, CCDS