After a thorough and comprehensive review by a panel of experts convened from the membership of the College, the American College of Emergency Physicians (ACEP) today informed the Surviving Sepsis Campaign (SSC) that ACEP will not endorse the organization’s latest update to guidelines for treatment of sepsis in emergency departments.
The decision to not endorse the guidelines was based on concerns about conflicting guidelines for the treatment of adult and pediatric patients, and a belief that the guidelines developed do not fully reflect the most up-to-date and reality-based approach to the care of all patients in the emergency department, including those with sepsis.
In addition, ACEP also remains deeply concerned that the absence of emergency physician organizational involvement in the governance structure of the Surviving Sepsis Campaign serves to limit the perspectives offered by practicing emergency physicians in the United States when guidelines are being developed.
While ACEP does have individual representatives involved in specific writing groups within the project, the governance structure is comprised of physician representation from the specialty of critical care medicine alone. Given that the emergency department environment is unique and facing incredible day-to-day challenges of hospital crowding/boarding and workforce shortages, ACEP believes that any guideline recommending care of patients in the emergency department should be based upon the realities of the practice care environment in which they are implemented. While acknowledging the importance of caring for patients with sepsis, the emergency department is also charged with caring for patients with many other critical and life-threatening conditions. For example, there appears to be little attention to the harm aggressive fluids and antibiotic treatment can cause when applied to too broad a population just to meet apparently arbitrary time requirements, particularly in the adult guidelines.
For the first time there are different guidelines for pediatric and adult patients. The guidelines for pediatric and adult patients were not aligned regarding both clinical treatment and operational pathways. ACEP believes that the recommended implementation of different clinical guidelines, for the same clinical condition, could lead to confusion among ED staff and lead to potential patient safety issues. In addition, ACEP is worried that the focus of the SSC is strictly on those patients with sepsis while appearing to ignore the potential harm the guidelines might cause for patients without sepsis.
The ACEP-convened expert panel provided direct feedback, with referenced citations of the published literature on sepsis, in response to the original draft guidelines. The concerns and recommendations for changes were acknowledged. A revised version of the guidelines was provided for review by ACEP. However, the final version that was developed did not adequately address the key concerns that had been identified in a manner that reflects the reality of practice within emergency departments in the United States.
ACEP will continue to work to ensure that guidelines developed for the care of patients with sepsis are based upon the strongest and most up to date science and are developed to ensure ease and effectiveness of implementation, while also reflective of the experience and realities of practicing emergency physicians.
