Sepsis Series, part IV
Sepsis: Where we stand now
Much confusion and controversy persists in regards to the Core Measures itself, as well as how the new Sepsis-3 definitions of sepsis might adjust the current guidelines. Despite Sepsis-3’s call to do away with the terminology of severe sepsis, it remains an important concept for Core Measures compliance.
As it stands, compliance with CMS Core Measures is an all-or-nothing pursuit. Either the care is compliant at every step, or it is not. And as pointed out previously, some of the Core Measures requirements, such as a 30 cc/kg fluid bolus in, say, a patient with severe CHF, can pose an actual danger to certain patients. Unfortunately, at this point, CMS does not allow for clinical judgment in regards to compliance with the measures.
The Sepsis-3 definition of SEPSIS = SUSPECTED INFECTION + qSOFA has also left many people scratching their heads. While the new consensus definitions shook up much of the discussion on how we look at risk stratifying patient’s with sepsis (using qSOFA rather than SIRS), it does little to help determine in which patients providers should be suspecting infection. Sepsis-3 does go as far as to say any patient with a unexplained organ dysfunction may have an unrecognized infection, but this broad definition makes “suspected infection” so broad it verges on meaningless.
The CEP Work
The Temple Content Expert Program a recently developed project that aims to promote resident education in core clinical topics while providing training in PI methodology, improve ED processes, and advance patient care through continuous application of updated best practices. Thus, the CEP has given a framework for improving the understanding of and care for septic patient in the ER.
One component of this program was the development of the below flow chart designed to help guide ED practitioners along the Core Measures compliant sepsis workup pathway.
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