Should you call it sepsis?
TWO definitions. ONE big problem.
Understand the problem and a solution in 1.5 minutes.
TWO definitions. ONE big problem.
Understand the problem and a solution in 1.5 minutes.
The problem?
๐ถ There are two definitions of Sepsis
๐ถ Neither definition is perfect
๐ถ One is arguably better for patient survival...
๐ถ But hospitals lose money if they use that definition
Let's dive in.
(Check out my previous thread for more info)
๐ถ There are two definitions of Sepsis
๐ถ Neither definition is perfect
๐ถ One is arguably better for patient survival...
๐ถ But hospitals lose money if they use that definition
Let's dive in.
(Check out my previous thread for more info)
1 / The definitions
First, names matter. What we call things guide how we treat them.
๐ถ Sepsis-2: 2/4 SIRS + Infection
๐ถ Sepsis-3: Infection isn't sepsis unless organ dysfunction is present
Sepsis-2 is "too sensitive" but recognizes sepsis early.
Why is this important?
First, names matter. What we call things guide how we treat them.
๐ถ Sepsis-2: 2/4 SIRS + Infection
๐ถ Sepsis-3: Infection isn't sepsis unless organ dysfunction is present
Sepsis-2 is "too sensitive" but recognizes sepsis early.
Why is this important?
Survival from early recognition and treatment of sepsis is well established.
Sepsis-3 is "too specific." It may miss some cases of early sepsis.
To save money, many insurances don't pay hospitals if they use sepsis-2 without end-organ damage. ONLY sepsis-3 (and SOFA criteria).
Sepsis-3 is "too specific." It may miss some cases of early sepsis.
To save money, many insurances don't pay hospitals if they use sepsis-2 without end-organ damage. ONLY sepsis-3 (and SOFA criteria).
2 / What could you do?
๐ถ Adopt sepsis-3 only and you may miss cases of sepsis, and patients suffer.
๐ถ Use sepsis-2, and insurances will refuse to pay you.
๐ถ Stop using "sepsis" all together? Patients, finances, and quality values all suffer.
So how can you fix this?
๐ถ Adopt sepsis-3 only and you may miss cases of sepsis, and patients suffer.
๐ถ Use sepsis-2, and insurances will refuse to pay you.
๐ถ Stop using "sepsis" all together? Patients, finances, and quality values all suffer.
So how can you fix this?
3 / Critically think. Medicine is not a cookbook.
1๏ธโฃ Use SIRS as a SCREENING tool. Not a diagnostic one.
Treat for sepsis empirically.
If it's ultimately not sepsis, document "ruled out" - this removes the diagnosis from coding.
2๏ธโฃ Consider other causes of SIRS.
1๏ธโฃ Use SIRS as a SCREENING tool. Not a diagnostic one.
Treat for sepsis empirically.
If it's ultimately not sepsis, document "ruled out" - this removes the diagnosis from coding.
2๏ธโฃ Consider other causes of SIRS.
3๏ธโฃ When end-organ damage is present, document "due to" sepsis.
This way:
๐ถ Patients get optimal care
๐ถ The bean counters are happy
๐ถ Your CDI department doesn't bug you with queries
๐ถ You satisfy CMS's compliance bundle (more in my newsletter)
You push both buttons!โคต๏ธ
This way:
๐ถ Patients get optimal care
๐ถ The bean counters are happy
๐ถ Your CDI department doesn't bug you with queries
๐ถ You satisfy CMS's compliance bundle (more in my newsletter)
You push both buttons!โคต๏ธ
In summary:
1๏ธโฃ Use SIRS as a SCREENING tool. Not a diagnostic one
2๏ธโฃ Consider other causes of SIRS.
3๏ธโฃ When end-organ damage is present, document "due to" sepsis.
Note: 2021 Surviving sepsis guideline adopts sepsis-3 but not qSOFA over SIRS as a screening tool.
1๏ธโฃ Use SIRS as a SCREENING tool. Not a diagnostic one
2๏ธโฃ Consider other causes of SIRS.
3๏ธโฃ When end-organ damage is present, document "due to" sepsis.
Note: 2021 Surviving sepsis guideline adopts sepsis-3 but not qSOFA over SIRS as a screening tool.
That's a wrap!
If you enjoyed this thread:
1. Follow me @Dr_Oubre for more of these
2. Subscribe to my newsletter to fully understand the CMS compliance bundle, Quality Impacts, Viral sepsis and more! robertoubremd.com
If you enjoyed this thread:
1. Follow me @Dr_Oubre for more of these
2. Subscribe to my newsletter to fully understand the CMS compliance bundle, Quality Impacts, Viral sepsis and more! robertoubremd.com
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