Judith Jacobi, PharmD, BCPS, FCCM
 Critical Care Pharmacist, Dept. of Pharmacy
 Methodist Hospital/Clarian Health Partners
 Indianapolis, Indiana, USA   

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Join the Creative Community
Joining the Society of Critical Care Medicine’s Creative Community is one of the most important contributions a member can make in helping the Society achieve its mission and vision. Applications to join are due May 15, 2010. Please note that reappointment to a committee is not automatic. If you are already a committee or task force member and your term is about to expire, you will need to reapply.

Members of the Creative Community not only play an active role in Society activities and initiatives, they also gain leadership skills and networking opportunities.

Visit the Membership section of www.sccm.org for more information. Find the new Creative Community Resource Center, which offers a complete guide to volunteer processes and opportunities.

During the 39th Critical Care Congress in Miami, Florida, USA, the terrible damage of the earthquake in Haiti unfolded for us through news coverage and reports from first responders. The scenes of devastation and complete disruption were horrific. Society of Critical Care Medicine (SCCM) volunteers and staff jumped into action immediately to offer support. In the week following the tragic event, a request for assistance came from SCCM member Alejandro Baez, MD, MPH. He expressed concern about the influx of Haitian patients taxing the limited intensive care unit (ICU) resources at the Santo Domingo hospital where he worked in the Dominican Republic. SCCM members responded immediately and, with the support of their colleagues filling in at home, traveled to the Dominican Republic. Marie Baldisseri, MD, FCCM; Randy Wax, MD, FCCM; M.J. Reed, MD, FCCM; and Dana Braner, MD, FCCM, were accompanied by SCCM staff Gervaise Nicklas, MS, RN, and Michael Huerta. Their task was to perform a needs assessment of ICU resources and recommend an appropriate response from SCCM. If you have not visited the blog describing their challenges and observations, I encourage you to do so at www.sccmblogs.org. More information on the effort, as well as the important role of the Fundamental Critical Care Support (FCCS) program, can be found on page 8. The situation was incredibly fluid during the first few weeks, with new challenges arising every day. Baez assumed the role as coordinator for medical care in the Dominican Republic, and his efforts in a highly stressful situation were exemplary.

The SCCM team visited a variety of hospitals and healthcare settings, including a facility on the border town of Jimani. Several critical care colleagues from Cooper Healthcare were already there – just one example of the incredible outpouring of time and resources contributed. The team determined that additional ICU beds were not needed immediately, as the USNS Comfort was due to arrive in Haiti to help provide relief. It did appear that an intermediate level of care was needed, and they provided advice on the equipment and resources that would be needed. In addition, they identified the need for additional education for local providers to expand their response capabilities for the difficult weeks and months ahead. An FCCS course was planned immediately. The Society supplied materials, including Spanish-language FCCS materials and English-language Fundamental Disaster Management (FDM) items, so Baldesseri and Reed could teach an FCCS course with a focus on the acute patient care needs specific to the area. Several disaster resources, including FDM slides that were quickly translated into Spanish, were posted to the SCCM Web site to facilitate a successful course.

The longer-term needs of the survivors of the Haiti earthquake are still becoming apparent. A sustained response is essential. Volunteers to organizations such as Project HOPE, Partners in Health, Doctors Without Borders and others have offered their services in great number. Society members who can participate are encouraged to contact those organizations. More information is available at www.sccm.org in the Disaster Resources section.

The role of these organizations in the administration and proper placement of volunteers is essential for a safe and productive response. The Society will continue to look for opportunities to support this important effort.

Likewise, SCCM will monitor the long-term needs of Chile, following their earthquake. The Society will support members in preparing for disasters whenever possible, through our existing resources.

Members who have or are participating in the relief response efforts are encouraged to post comments on the SCCM blog and provide advice to others who may assist in the future. The stories are compelling, and I encourage you to read about your colleagues’ important contributions. The emotional toll on some of our first responders was significant. Special thanks to their co-workers for providing support in the weeks and months to follow.

I also want to recognize the many members of the SCCM staff who worked tirelessly to support our volunteers. It is just one example of their dedication to the care of our patients.

Quality Initiatives at Home
We also have made significant progress on several SCCM initiatives to support quality care and measurement. Developing effective roles on the dynamic playing field of performance measurement can be challenging. Traditional advocacy activities, such as educating elected officials, are expensive and have not been prioritized in the face of economic limitations. However, individuals within SCCM have identified potential opportunities that have led to discussions with key healthcare groups.

Harmonization of national measures depends extensively on endorsement by the National Quality Forum (NQF). Our liaisons and their staff partners already participate in the American Medical Association (AMA) Physician Consortium for Quality Improvement (PCQI), the Hospital Quality Alliance (HQA), and the NQF. We are taking steps to reorganize these liaisons into a new committee with a focus on quality and safety. We aim to participate more proactively through discussions with key healthcare committees. Society members with an interest in quality initiatives are encouraged to volunteer. If you wish to become part of SCCM’s Creative Community in this or any other capacity, visit the SCCM Web site and apply by May 15, 2010.

Although we have had liaison activity with the NQF, our voice may be diluted in this large group of member organizations dedicated to development and implementation of healthcare quality measures and reporting. However, NQF President and CEO Janet Corrigan, PhD, MBA, was a featured speaker at the 39th Critical Care Congress. In her Peter Safar Honorary Lecture, available at www.sccm.org/CongressDaily, she thoroughly described the priorities and goals for transforming the healthcare system. New process measures are endorsed regularly by NQF, and more than 500 have been listed thus far. However, few focused critical care measures exist beyond prevention of hospital-acquired infections, and we aim to lead or assist in this process. The Society will continue to pursue opportunities to develop a more active role within the NQF. A complete listing of currently developed and endorsed measures relevant to critical care is beyond the scope of this column, but many critical care measures are collected at www.qualitymeasures.ahrq.gov.

In conjunction with our partners from the Critical Care Societies Collaborative (the American Association of Critical-Care Nurses, the American College of Chest Physicians and the American Thoracic Society), we have been meeting with Department of Health & Human Services (HHS) Deputy Assistant Secretary for Healthcare Quality Donald Wright, MD, MPH, and his staff to discuss partnership opportunities related to initiatives to reduce and eliminate hospital-acquired infections, especially bloodstream infections and ventilatorassociated pneumonia. We hope the combined voice of our 100,000 critical care practitioners enhances the opportunity to influence the development of future process measures. One example of the effective partnership between HHS and SCCM is the online course Critical Care Cross-Training for Hospital-Based, Non-ICU Healthcare Providers (CCXT), available at www.learnICU.org/CCXT. This tool educates non-ICU clinicians on responding safely and effectively to a pandemic situation; it also addresses proper utilization of Strategic National Stockpile ventilators.

The guidelines development process, managed by the Board of Regents of the American College of Critical Care Medicine, also serves an important role for performance measure development. These guideline statements and associated implementation toolkits lay the foundation for development and endorsement of national performance measures. However, testing of the impact on patient outcome with these individual or bundled care measures remains inadequate to drive the process to completion.

Aspects of external reporting can be frustrating and timeconsuming for clinicians; they can potentially compete with resources for front-line care. As individual practitioners, we have developed programs to address safety and quality, but we are challenged to measure our progress and the impact on patient outcome. The imperative to measure and provide external reporting may facilitate justification of new hospital positions with this focus. If you have developed a process to accomplish measurement, e-mail me at president@sccm.org, so I can share your stories for the benefit of others. While healthcare reimbursement is changing in Washington, D.C., the potential impact is far from clear. We will continue efforts to enhance our activities in the quality arena. Reports on our progress will continue throughout the year.