If definition usefulness is based on priorities, it seems important to know what is valued the most by the clinicians who are implementing the definition.
Explore This IssueACEP Now: Vol 37 – No 11 – November 2018
“Labeling already differentiated ICU patients is very different than sorting, or triaging, undifferentiated patients in the ED or on hospital wards.” —David Gaieski and Munish Goyal
Surviving Sepsis Campaign
ACEP’s involvement with the SSC began in 2003, when an emergency physician who had just completed a critical care fellowship was in Amsterdam taking the European critical care boards at the European Society of Intensive Care Medicine annual congress, as the US boards were not an option. While there, the physician went to the SSC presentation in an auditorium filled with hundreds of intensivists and listened to the Phase II and III plans for this international critical care collaborative. During the question period, the emergency physician asked a simple inquiry: “If 50 percent of sepsis in the United States presents through the emergency department, would it be of benefit to have emergency medicine involved?”
A proposal was drafted, and conversations with the ACEP Board of Directors began through Arthur Kellermann, MD, MPH, FACEP. A lecture with panel discussion was arranged for the ACEP Scientific Assembly. In a room accommodating 200 people, approximately 25 people attended that inaugural lecture. There were no other sepsis talks at ACEP that year.
Sepsis didactics became a standing component of Scientific Assembly. An article documenting ACEP’s alliance with the SSC and a letter from the ACEP president regarding ACEP’s involvement were sent to 35,000 members. During this time, sepsis mortality was high, with an estimated 500 deaths per day in the United States alone. As part of Phase I, Graham Ramsay, MD, conducted a survey of more than 1,000 physicians from six countries and found fewer than 17 percent of physicians agreed on a common definition or a standard treatment. In 2003, ACEP participated with representatives from 11 international medical professional organizations in the creation of the first set of sepsis management guidelines advising a standardized management approach to sepsis. Guided by Phillip Dellinger, MD, there was meaningful collaboration. During periods of intense academic discussion, where few agreed on how specific data were interpreted, he would carefully consider the different perspectives and then skillfully find common ground. ACEP contributed meaningfully with 100 percent of the major content revisions and 75 percent of moderate content revisions accepted. Through Phase III, headed by Mitchell Levy, MD, from the SSC, and Sean Townsend, MD, from the Institute for Healthcare Improvement (IHI), an innovative approach of structured, data-driven implementation was taken. Although there were periods of academic differences of opinion on specific elements of the guidelines, the representatives generally came to a consensus and worked collaboratively with mutual respect.