Sepsis or Not?
Cesar M Limjoco MD
Chief Medical Officer | Board Advisor | Keynote Speaker | 26k+ Linkedin followers/connections
84 year old patient met Sepsis criteria and was started on Sepsis Protocol. Next day, combination IV broad spectrum antibiotics were stopped. Oral ciproflaxin started and discharged home.
Caveat emptor -- elderly patients get dehydrated and may present with symptoms (e.g., fever, altered mental status and hypotension) that resolve with a few hours of IV rehydration. They can also have Cr bumps caused by hemoconcentration with no true kidney injury. (Clinical studies have shown that Cr bumps due to hemoconcentration in dehydration resolve within 6 hours of IV hydration with no kidney insult.) Elderly folks also frequently develop simple UTIs.
Whatever Sepsis Criteria is used, it is critical that the documentation discloses the distinction between a regular response to infection versus a dysregulated response to infection with organ dysfunction. Need to rule out other contingencies. The distinction may not be apparent at the outset. The hospital course will make it unambiguous. The CLINICAL TRUTH needs to be self-evident in the narrative.
#ACDIS #AHIMA #acutecare #sepsis #denials #medicalcoding #clinicaldocumentation #integrity #CDI #medicalnecessity #physicianadvisors
Chief Medical Officer | Board Advisor | Keynote Speaker | 26k+ Linkedin followers/connections
5 年#CalltoAction. People do understand the magnitude of Sepsis. Criteria and protocol's attempts to encapsulate it may have inadvertently misled some to misuse and overdiagnose, but there is a common thread through it all...https://www.dhirubhai.net/posts/cesarmlimjocomd_calltoaction-sepsis-cdi-activity-6597151528673521664-DoR7
Physician Advisor at Brundage Group
5 年I didn't write the criteria.? ?I just read them.? ?I agree with James S. Kennedy, MD, CCS?that oral antibiotics in 2019 are very powerful and effective.? ?IV is no longer necessary to show severity.? ?Treatment is clinically supportive, but does not confirm nor rule out a diagnosis.?? I disagree with the discussion that "sicker than the average patient" is necessary.? ?"Sicker" to the family practice doctor compared to "sicker" to the critical care doctor is not a reliable reproducible manner for diagnosing our patients.?? Use the criteria.? ?Use all of them.? ?They are not hard to use.? ?They only require clinical attention.? Organ dysfunction consequent to the infectious process is a very reasonable and defensible stance for the diagnosis of (severe) sepsis.? ?Treat your patient.? ?Save him/her.? ?Track quality.? ?Reduce mortality.? Diagnose and reduce your risk of denial.? ? That's all.? ?Easy.? Don't make it harder than it already is.?
Vice President, Physician Advisory Solutions at R1 RCM, Advisory Board of American College of Physician Advisors and National Association of Healthcare Revenue Integrity, differentiator between acronyms and initialisms
5 年No dysregulated response to the infection, no sepsis.
Creator of Dr. Remer's Documentation Modules
5 年Sepsis is a real condition with a clear definition but no distinct diagnostic criteria. It is life-threatening organ dysfunction due to a dysregulated host response to infection. These are patients who are sicker than the average patient with that same infection and in jeopardy of dying if sepsis is not recognized and treated.? I do not subscribe to "abnormal vital signs = systemic inflammatory response syndrome". Fever is a common physiological response to an infection and is often accompanied by a tachycardia. The patient is NOT necessarily septic. I agree with James S. Kennedy, MD, CCS?that highly bio-available oral Abx may be transitioned to rapidly and that does not rule out having sepsis initially. Duration of intravenous antibiotic treatment is not a factor in any sepsis scenario.? Patients whose underlying condition doesn't necessitate inpatient care may have short stays if their sepsis is treated appropriately, aggressively, and the sepsis expeditiously responds. Infected stent and stent removed, source eliminated; sepsis can resolve rapidly. If you have sepsis from a UTI, how long do you need to keep the patient in the hospital once the sepsis and organ dysfunction resolves? My answer is, "Possibly." #sepsis?
President of CDIMD - ICD-10 Physician Champions
5 年Oral antibiotics can be highly absorbable, such as levofloxacin (95%). Just because someone discontinued IV antibiotics doesn’t mean that they don’t have sepsis, given that they transitioned to oral therapy to treat the condition. The better question, in my mind, is if the patient only has a 1-overnight stay and is discharged home, do they really have sepsis? Possibly with Sepsis-2; never with Sepsis-3.