Terry Thank you for your excellent comments-well put Thanks,
Mary Ann Daly, RN BSN CCRN DC Regional Lead-Sepsis Gordon and Betty Moore Foundation Grant Sutter Health Sacramento Sierra Region E-mail: [email protected]<mailto:[email protected]> Blackberry: 916.200.5604 Office: 916.614.6370 Please consider the environment before printing this e-mail IMPORTANT CONFIDENTIALITY NOTICE: This E-mail (including any documents referred to in, or attached, to this E-mail) is intended only for the name addressee may contain information that is personal, confidential/privileged or the subject of copyright or other proprietary rights in favor of Sutter Health, its affiliates or third parties. If you received this E-mail by mistake you should: (1) not copy, disclose, distribute or otherwise use it, or its contents, without the consent of Sutter Health or the owner of the relevant rights; (2) let us know of the mistake by reply E-mail or by telephone (916.453.5121); and (3) delete it from your system and destroy all copies. Any personal information contained in this E-mail must be handled in accordance with applicable privacy laws. From: [email protected] [mailto:[email protected]] On Behalf Of Terry Clemmer Sent: Thursday, December 15, 2011 7:53 AM To: [email protected]; [email protected]; [email protected] Cc: Terry Clemmer Subject: Re: [Sepsis Groups] Paul E. Marik Quality improvement is always about change. It is important to build that into our systems so when new information becomes available we can continue to grow and improve. We saw this with the "Nice-Sugar" and with "Corticus" publications, and now with the demise of rAPC availability. When the "ProCess" study finishes we may see it again. The same is now ongoing with new challenges to the use of the CVP measurement as new technologies are being developed. The sepsis bundle is not sacred. That is why the SSC revises the guidelines on a regular basis, 2004, 2008 and now 2012. Don't despair this again is and opportunity to make it better. Focus on building robust systems of change that can deal with these changes with less effort and pain. Be careful however, to not jump to quickly on every new publication, it sometimes take time until new concepts are truly validated. Tight glucose control is an example. At other times certain concepts never die, ECMO is one of them in which the benefit has never been proven in good randomized studies but continues to grow in popularity anyway. Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital, 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: [email protected]<mailto:[email protected]> "Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq." From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of [email protected]<mailto:[email protected]> Sent: Friday, December 09, 2011 8:54 AM To: [email protected]<mailto:[email protected]>; [email protected]<mailto:[email protected]> Subject: Re: [Sepsis Groups] Paul E. Marik I received the article from one of our ED physicians and physician champion for our sepsis campaign. So I feel your pain. It hasn't helped me move this project forward! Susan M. McKinney RN eICU®/Sepsis Quality Coordinator Clinical Effectiveness Team Rapid City Regional Hospital 605-390-1679 Pager 1725 From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Carina Idiesca Sent: Thursday, December 08, 2011 10:50 PM To: sepsis family Subject: [Sepsis Groups] Paul E. Marik Dear All, I would like to ask for a feedback regarding an article authored by Paul E. Marik which was published in the Annals of Intensive Care 2011 1:17. The article is entitled " Surviving sepsis:going beyond the guidelines". Much to my chagrin, it contained unfavorable reviews of the SSC bundles. Hoping to hear from you all, Carina MD. USA PS Since the NICE-SUGAR study, is the majority still using intensive insulin therapy drip for hyperglycemia in the ICU patients? Our pharmacist shared an article (details & source to follow, apologies) regarding the use of insulin drip to treat hyperglycemia as a weak recommendation. Thanks. ________________________________ Regional Health's mission is to provide and support health care excellence in partnership with the communities we serve. Note: The information contained in this message, including any attachments, may be privileged, confidential, or protected from disclosure under state or federal laws . 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