Surviving sepsis 2018

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This is stupid.

My ICU is cardiac-focused (medical cardiac and surgical cardiac), along with whatever else. I got dinged by the documentation police because I was documenting "sepsis" but NOT giving 30 mL/kg to my patients with low EF or ESRD - they told me I was "practicing outside of Medicare guidelines, so we won't get paid". So I asked them to email me their request to treat patients in a manner I deemed harmful, in order to improve billing. They won't do that. I know it's stupid. They know it's stupid.

The whole thing is stupid.

FFP - thanks for the link to the petition. I signed.
 
Any organization that imposes healthcare protocols that cannot be overruled by physicians is made up of *****s, the kind that get people killed.

I don't know why one of our "critical care societies" doesn't sue Medicare for all the sepsis bundle crap (plus other non-scientific "performance measures"). They need better leaders or better lawyers.
 
Last edited by a moderator:
bigdan said:
This is stupid.

My ICU is cardiac-focused (medical cardiac and surgical cardiac), along with whatever else. I got dinged by the documentation police because I was documenting "sepsis" but NOT giving 30 mL/kg to my patients with low EF or ESRD - they told me I was "practicing outside of Medicare guidelines, so we won't get paid". So I asked them to email me their request to treat patients in a manner I deemed harmful, in order to improve billing. They won't do that. I know it's stupid. They know it's stupid.

The whole thing is stupid.

FFP - thanks for the link to the petition. I signed.
Click to expand...

Tell them 30mL/kg only applies for severe sepsis, not regular sepsis.

Damn life saving 6 hour reassessment notes also need to die.

I listened to Manny Rivers give a lecture on this a few months back, surprise! He's part of the Medicare committee that passed the fluid for all regulation. He had weak ass data and his whole lecture seemed to ignore the process study...and the fact that usual care did better than EGDT. But let's not let that embarrassing fact get in the way.

Sadly this will likely take a combination of professional societies and Hospitals to sue this crap out of existence.
 
The Surviving Sepsis Campaign is probably sponsored by the makers of Lasix and Vascath...

I do love this though:
Guidelines said:
Rapidly administer 30 ml/kg crystalloid for hypotension or lactate≥4 mmol/L ........................ Strong recommendation, low quality of evidence
Click to expand...
Literally an oxymoron...
 
Hernandez said:
Tell them 30mL/kg only applies for severe sepsis, not regular sepsis.

Damn life saving 6 hour reassessment notes also need to die.

I listened to Manny Rivers give a lecture on this a few months back, surprise! He's part of the Medicare committee that passed the fluid for all regulation. He had weak ass data and his whole lecture seemed to ignore the process study...and the fact that usual care did better than EGDT. But let's not let that embarrassing fact get in the way.

Sadly this will likely take a combination of professional societies and Hospitals to sue this crap out of existence.
Click to expand...
How can somebody who seems to be so ethically-challenged be part of Medicare? How is that guy still in academia in the first place?
 
bigdan said:
This is stupid.

My ICU is cardiac-focused (medical cardiac and surgical cardiac), along with whatever else. I got dinged by the documentation police because I was documenting "sepsis" but NOT giving 30 mL/kg to my patients with low EF or ESRD - they told me I was "practicing outside of Medicare guidelines, so we won't get paid". So I asked them to email me their request to treat patients in a manner I deemed harmful, in order to improve billing. They won't do that. I know it's stupid. They know it's stupid.

The whole thing is stupid.

FFP - thanks for the link to the petition. I signed.
Click to expand...

Is that for real? If you don’t bolus your septic 100kg heart patient 3L you get a ding? That’s insane. What then, when his pressure drops more from overload do you have to bolus him more?
 
FFP said:
Any organization that imposes healthcare protocols that cannot be overruled by physicians is made up of *****s, the kind that get people killed.

I don't know why one of our "critical care societies" doesn't sue Medicare for all the sepsis bundle crap (plus other non-scientific "performance measures"). They need better leaders or better lawyers.
Click to expand...

Because they were made for checklist filling nurse practitioners. Then they come around and say "hey we are just as good as you" because they know how to check the boxes
 
bigdan said:
This is stupid.

My ICU is cardiac-focused (medical cardiac and surgical cardiac), along with whatever else. I got dinged by the documentation police because I was documenting "sepsis" but NOT giving 30 mL/kg to my patients with low EF or ESRD - they told me I was "practicing outside of Medicare guidelines, so we won't get paid". So I asked them to email me their request to treat patients in a manner I deemed harmful, in order to improve billing. They won't do that. I know it's stupid. They know it's stupid.

The whole thing is stupid.

FFP - thanks for the link to the petition. I signed.
Click to expand...

In residency we had a “sepsis RN” who’s job it was to make sure compliance was kept with sepsis treatment (side note - critical care at my institution was a disaster when I was there, slowly improving). She would hound the hell out of us on the 30 mL/kg bonus and screamed Plasmalyte didn’t count it had to be NS. Ridiculous, and somehow she had the surgeons backing.

Just thinking about it made my blood boil. There’s a reason my program pulled the residents from trauma and surgical ICUs for the most part when I left.
 
AdmiralChz said:
In residency we had a “sepsis RN” who’s job it was to make sure compliance was kept with sepsis treatment (side note - critical care at my institution was a disaster when I was there, slowly improving). She would hound the hell out of us on the 30 mL/kg bonus and screamed Plasmalyte didn’t count it had to be NS. Ridiculous, and somehow she had the surgeons backing.

Just thinking about it made my blood boil. There’s a reason my program pulled the residents from trauma and surgical ICUs for the most part when I left.
Click to expand...

This is another example of ridiculous protocol driven but mindless nursing care. But hey box checked, right??
 
AdmiralChz said:
In residency we had a “sepsis RN” who’s job it was to make sure compliance was kept with sepsis treatment (side note - critical care at my institution was a disaster when I was there, slowly improving). She would hound the hell out of us on the 30 mL/kg bonus and screamed Plasmalyte didn’t count it had to be NS. Ridiculous, and somehow she had the surgeons backing.

Just thinking about it made my blood boil. There’s a reason my program pulled the residents from trauma and surgical ICUs for the most part when I left.
Click to expand...

Sounds like an idiot. There are so many jobs created for *****s to make people follow mentally handicapped rules.
 
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