Q&A: Facility-specific sepsis criteria
and Cesar M. Limjoco, MD,
answered this question
Q: Is it a best practice for a hospital to get a consensus within their own facility to use one sepsis criteria over another?
A: Yes, I definitely think it is best practice to do that. We do have a sepsis committee at our hospital and they’re currently working on this. It’s also a good argument when you get a denial, because you can say, this is the criteria we apply every single time we have a sepsis case.
I think it is difficult to stick to one set of criteria all the time, though, because patients can present very differently at the beginning of their admission. But, in my opinion, I would rather err on the side of thinking that it’s sepsis and treating it like sepsis in the beginning and then quickly deescalating if the patient doesn’t seem to be septic rather than missing your sepsis cases in the beginning, querying after the fact, and potentially having a core measures problem.
The other thing to consider is that the quick sequential organ failure assessment (qSOFA) is great within the first hour the patient presents to the hospital. After six hours or so, though, your regular SOFA criteria becomes more credible because now you have more findings of organ dysfunction that are going to be presenting at that point.
If you use them in combination—you use qSOFA as the screening protocol and then SOFA criteria later on—then you will have a more complete picture of this patient.
Also, if your qSOFA was negative early on, after six hours or so, the patient may actually fulfill the regular SOFA criteria. If the patient is negative with qSOFA, it doesn’t mean that they don’t have sepsis. You have to follow the narrative. And you have to show that there is documentation that even though the patient did not meet criteria at this particular time, they did later on during the admission.
Editor’s note: Shelly McBrayer, BSN, RN, CCS, CCDS, CDI coordinator at Chesapeake (Virginia) Regional Healthcare and Cesar M. Limjoco, MD, CDI physician advisor consultant, answered this question during the webinar “Sepsis: Resolving Documentation and Coding Conflicts through CDI,” originally broadcast on July 19. The session will be rebroadcast on October 18, 1-3 p.m. eastern. Click here to learn more.