Q&A: Establishing an organizational definition of sepsis
Q: I am working in conjunction with a sepsis coordinator for my organization and we are putting together a business case as to why we need an organizational definition of sepsis. I know that several other organizations have mentioned that they were able to accomplish this. Can you offer background on how you were able to propose this to your leadership, as well as some examples of what your definitions are related to sepsis, Systemic Inflammatory Response Syndrome (SIRS), shock, etc.?
Response #1: Our CDI team aligned with the CMS definition of severe sepsis and acknowledge sepsis when the patient has SIRS (not related to another condition) and an infection. The biggest challenge has been the potential influence of severe sepsis and septic shock queries on the time zero element, especially if the present on admission (POA) status needs to be clarified. The goal of our CDI queries is to ensure accurate code assignment while not causing any inaccuracy in time zero for severe sepsis.
Response #2: Our organization recently changed from Sepsis-2 criteria to Sepsis-3. We created a sepsis definition and documentation work group that included physician and APP champions from multiple specialties, a physician advisor, coworkers from compliance, quality, coding, CDI, a clinical nurse specialist, as well as care design and optimization. Together, we identified the reasons why the change of definition was necessary, what was required to do so, who we needed involved in the workgroup, how we would transition to Sepsis-3 criteria, how we would educate, and how we would measure the impact of the change. We continue to monitor, educate, and learn together in this process but it has overall been a successful transition.
Response #3: For the sepsis criteria dilemma at our organization, physician leaders and sepsis team members met, reviewed Sepsis criteria, and decided to use Sepsis-2 criteria for their sepsis alerts and diagnosing of sepsis. Best practice sepsis protocols are used. CDI specialists and coders query based on the Sepsis-2 criteria, and our CDI sepsis queries, written by CDI leadership, ask for clinical indicators, cause of sepsis, a link to an organ failure (if applicable), and POA status. Each sepsis query also contains a sepsis table with criteria for sepsis, severe sepsis, and septic shock. Our denials team uses the Sepsis-2 criteria decided by the physician leaders to appeal sepsis denials. For us, it was decided by these physician leaders who continue to meet and update the criteria as needed.
Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council. For the purposes of this article, all Council member answers have been deidentified.