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SEPSIS AND SEPTIC SHOCKFebruary 14, 2017
Sepsis and Septic Shock
David Sweet, MD• Education Director for the ICU at Vancouver General Hospital• Attending physician in Emergency and Critical Care Medicine• Provincial clinical lead for sepsis quality improvement with the BC
Patient Safety and Quality Council• Emergency Medicine (FRCPC)• Critical Care Medicine (FRCPC)• Transesophageal Echocardiography• Vancouver General Hospital
Ryan Hosken, RN Director of Quality and Performance Improvement, Patient Safety, WSHAPhone: 206-577-1821, Email: [email protected]
o 900 bed Quaternary academic centero 90,000 ED visits/yearo 1400 ICU admits/year
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017
Sepsis Safety Action Bundle -*new* 6/14/2016
http://www.wsha.org/wp-content/uploads/FINAL_2016_06_09_SAB_SEPSIS-1.pdf
Measuring ResultsHospitals measure the results of their efforts through a variety of regulatory submissions.•Sepsis (SEP-1) per Centers for Medicare and Medicaid reporting requirements.•Post-operative Sepsis (PSI-13) per AHRQ Quality Indicator reporting requirements.•Severe Sepsis Mortality based on ICD9 or ICD10 coding as identified via CHARS data.WSHA reviews sepsis mortality data and provides comparative reports to hospitals to assist them in identifying opportunities for improvement.
Useful LinksPresentation – Safe Table Webcast: Sepsis (Part I and II) – Dec. 5, 2014Link to the recorded WebcastPresentation – Safe Table Webcast: Sepsis (Part III and IV) – Dec. 17, 2014Link to recorded Webcast
Resources
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017
Sepsis and Septic Shock
Numerator
Number of inpatient deaths in hospital due to severe sepsis with or without septic shock.
Denominator
Total number patients diagnosed with severe sepsis with or without septic shock.
Inclusion
ICD-10 Sepsis Codes:
A021, A227, A267, A327, A400, A401, A403, A408, A409, A4101, A4102, A411, A412, A413, A414, A4150, A4151, A4152, A4153, A4159, A4181, A4189, A419, A427, A5486, B377, R6520, R6521, T8112XA
Measure
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017
Sepsis and Septic Shock
Exclusions
Patients with advanced directives for comfort care and that refuse treatment.
ICD-10 Exclusion codes:
Z530 Refuse treatmentZ515 Comfort careZ5321 Left against medical advice (AMA)
Agency for Healthcare Research and Quality issued Patient Safety Indicators #13 (PSI #13) related to Postoperative Sepsis. Pages 4 and 5 highlight the ICD-10 codes for Sepsis in general. Code T8110XA is excluded in our measure as shock is unspecified.
https://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50-ICD10/TechSpecs/PSI%2013%20Postoperative%20Sepsis%20Rate.pdf
Measure
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017
Sepsis and Readmissions
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017
"The analyses upon which this publication is based were performed under Contract Number HHSM-500-2016-00077C entitled, "Hospital Improvement
Innovation Network," sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services."
Early Recognition and Treatment of Sepsis: The Canadian Approach
Presented at WSHA-ASHNHA Partnership for Patients Safe Table –February 14, 2017