Evidence for the 1-hour bundle release by the Surviving Sepsis Campaign is weak. Yet, this is the new standard we are held to, despite ACEP, AAEM, and thousands of physicians, EM and non-EM alike, voicing concern that this is a very bad idea.
The physician response to an incendiary tweet by the NRA last week has been striking. It has led to the hashtag #ThisIsOurLane, as the NRA admonished physicians to “stay in their lane” regarding gun policy. This is a review of the position statement by the American College of Physicians on reducing firearm deaths and injuries that sparked it all.
Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.
Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues. This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.
Patient satisfaction is important. But the most commonly used metric in the US, the Press Ganey survey, may not be a good measure of individual emergency physician and clinician performance. Giving emergency clinicians feedback on their Press Ganey scores, ostensibly so they could take steps to improve, did not lead to appreciable score improvements.