Sepsis Onset Time Criteria

The Reporting system uses the following criteria to define a time, referred to as Sepsis Onset Time (Time Zero), that shall denote when a patient is suspected of having become Septic. This supports the Sepsis Bundle Compliance report.

Sepsis Time Zero is identified as follows:

• Sepsis Diagnosed Condition onset date, if present
• If the Sepsis Diagnosed Condition onset date is not present, the earliest of the following dates is used:
  • Sepsis Diagnosed Condition first appearance of system last modified date
  • The latest date among the Sepsis Criteria that identified the condition
    • Suspicion of Infection indicated by any of the following:
      • A Suspicion of infection Diagnosed Condition (onset date when present, otherwise first appearance of system last modified date)
      • A Suspicion of infection Observation (effective start date when present, otherwise issued date)
      • Medication Request administered for an infection (authored date when present, otherwise system last modified date)
      • Medication Administration for an infection (effective start date when present, otherwise system last modified date)
    • Observation effective date (or issued date if effective date is not present) of the last Observation that identified Severe Sepsis presence

Context Sepsis Time Zero will be used in determining the time frame for both Sepsis and Severe Sepsis bundle compliance.

Sepsis Criteria, identified as follows:

• Sepsis Condition Diagnosed
• OR, all of the below documented within 6 hours of each other.
  • Suspicion of Infection indicated by any of the following:
    • A Suspicion of infection Diagnosed Condition (onset date when present, otherwise first appearance of system last modified date)
    • A Suspicion of infection Observation (effective start date when present, otherwise issued date)
    • Medication Request administered for an infection (authored date when present, otherwise system last modified date)
    • Medication Administration for an infection (effective start date when present, otherwise system last modified date)
  • Two SIRS criteria met within three hours of each other, where the later date falls within the 6 hour time period for identification (Observation effective date, or issued date if effective date is not present):
    • Temperature > 38 or < 36 degrees Celsius
    • Heart rate > 90 beats per minute
    • Respiratory Rate > 20 breaths per minute or PACO2 < 32 mmHg
    • White Blood Cell count > 12,000 or < 4000 mm3 or Bands > 10%
  • Organ dysfunction evidenced by any one of the following Observations (observation effective date, or issued date if effective date is not present):
    • Systolic blood pressure < 90 mmHg
    • NIBP_MAP < 65 mmHg
    • Creatinine > 2.0 mg/dL
    • Total bilirubin > 2mg/dL
    • Platelet count < 100,000 mm3
    • INR > 1.5
    • PTT > 60 seconds
    • Lactate > 2.0 mmol/L

Medication Requested or Administered for an infection could include, but is not limited to, broad-spectrum antibiotic or crystalloid fluid.