Sepsis Data Collection

EBAA is working to collect data from EBAA-Member eye banks regarding sepsis cases. Please note – all data submitted on this form should be from 2023 only. If you have any questions about the data, please contact Jennifer DeMatteo.

Due Date: July 12

Sepsis Data Collection

Phone

This field is for validation purposes and should be left unchanged.

Contact Information

Executive Director/CEO Name

Eye Bank Name

Should the ED/CEO be the point of contact regarding this topic?

Yes

Point of Contact Name

Point of Contact Email Address

Eye Bank Procedures

List the name(s) of your infectious disease consultants, as well as the estimated percentage of time you use each consultant. Click the + on the right to add additional ID consultants.

ID consultant name

Percentage of time ID consultant is used

Upload MedWatch reports for any surgery from 2023.

Drop files here or

Max. file size: 256 MB.

Upload your eye bank's SOP on handling sepsis cases.

Drop files here or

Max. file size: 256 MB.

Upload your eye bank's sepsis algorithm for determining sepsis cases.

Drop files here or

Max. file size: 256 MB.

Eye Bank Data – Responses to questions should ONLY be from 2023.

Total number of referrals

Total number of referrals with sepsis concerns

Total number of referrals deferred/closed due to sepsis concerns

Total number of donors recovered with sepsis concerns

Total number of donors approved for transplant via sepsis algorithm

Total number of donors approved for transplant via Sepsis/Infection Consult with:

Medical Director

ID Consultant

Attending Physician

Total number of donors deferred/closed due to sepsis algorithm

Total number of donors deferred/closed due to Sepsis/Infection Consult with:

Medical Director

ID Consultant

Attending Physician

Total number of sepsis concerning donors who were determined eligible and were transplanted

Total number of infectious adverse reactions

Total number of infectious adverse reactions for donors approved with sepsis concerns

For Donor Eligibility, does your eye bank review the entire record for the most recent hospital admission?

Yes

How many days proceeding death do you review the medical record for signs and symptoms of sepsis?

Include any additional information you'd like EBAA to have.

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