1. Sepsis Fall Out Presentation
Name & Credentials
Date:

2. Instructions for Presentation
Use this template to write- up your Severe sepsis/ Septic shock fallout
Keep the presentation to 10 minutes
No more than 5 power point slides
Use the prompts in each slide to answer questions
Send presentation to Yuhan Kao, Mary Lawanson-Nichols & your UD, CNS/Educator ONE week before your presentation
Select the huddle message that will be sent to all units for the month base upon your presentation. Collaborate with unit leadership on how to disseminate
For assistance please contact your Unit leadership or Yuhan for Ronald Reagan or Mary for Santa Monica

3. Patient Background: Brief Medical History:
Reason for current Admission :
Admit Date:
Admit Time:
Suspected or Confirmed Infection:
Date & time:

4. Sepsis Criteria: >2 SIRS Criteria: Date & Time
New Organ System Dysfunction: Date & Time
POSITIVE for Septic Shock:
Time of Presentation with date (TOP):
Screened appropriately?

5. Severe Sepsis: (note date & TOP) Septic Shock (note date TOP)
IV Fluids: Date & time appropriate amount for weight?
Vasopressive Meds: Date & time:
Blood Cultures x2 Date & Time: Lactate & Repeat Lactate Date & Time: Antibiotics- Name & time given
Enrolled students: 729
Note: Current students – including students taking classes/coursework AND students on a leave of absence): 856
Source: Linda Cuesta, Registrar/Manager of Student Records, DGSOM
Date: September 2016
Postdoctoral fellows:  529
Source: Ren Sun, Senior Associate Dean of Graduate Studies/Associate Vice Provost, DGSOM
academic year
Clinical fellows: 476
Includes: ACGME fellows: 302
Non-ACGME fellows: 174
Source: Kate Perkins, DIO, DGSOM
September 2016
Source: Stephanie Shaw, Director, Academic Affairs, DGSOM
Residents: 967
Includes: Fellows in ACGME programs: 302
Total faculty: 3,232
Full-time faculty: 2,726
Part-time faculty: 506
NIH research dollars: $291M
Source: Blue Ridge Institute for Medical Research, via D. Baybridge.
Year: New data available after Oct. 1, 2016.
External funding: More than $650M annually
Source: Harry Yang, assistant director, data management, UCLA Research Administration
Year: FY2016

6. Debriefing: What were went well? Where were the initial fallouts?
Areas of Improvement:
Take Home Points:

7. Huddle Message: From the Sepsis Champions
Name of Sepsis Champion: Unit: (note if from RR or SMH)
If you have any questions contact your unit Sepsis Champion(s)