CEO's Message: 2018 Annual Report

David J. Martin, CAE

The Society of Critical Care Medicine’s (SCCM) mission is to “secure the highest-quality care for all critically ill and injured patients.” While the phrase is deceptively simple, the scope of the challenge is large. Every year in the United States alone, more than six million people are admitted to hospital intensive care units (ICUs). The cost of their care exceeds $100 billion. More than half of all U.S. emergency department visits result in an ICU admission. In both the United States and abroad, however, many critically ill patients still do not have ready access to an ICU or a trained critical care provider.

Founded in 1971, SCCM began with a vision—one shared independently by many from different backgrounds, cultures, and even continents. It was a vision of how best to care for the critically ill and injured—not only via treatments and therapies, but via care provided by a team of professionals not limited by titles, specialties, or organ systems. This idea was one of a group of multidisciplinary and multiprofessional caregivers with a unified focus— improving the care and outcomes of the sickest and most fragile of all patients.

This is a summary of our activities in the last year aimed at advancing our missions.

Visit sccm.org/AnnualReport for more information 

How We Improve Care

SCCM achieves its mission in two fundamental ways. We encourage and support research, and we educate healthcare providers, patients, and the public.

Research: SCCM highly values critical care research. It provides important information about disease trends and risk factors, outcomes of treatments and health interventions, and patterns of care, as well as new treatments.

Education: Critical care is a relatively new specialty in the medical field. The first ICUs were established in the 1950s, and the specialty of critical care medicine began to develop. Since SCCM’s founding, educating and training clinicians to care for critically ill patients has been a key focus. From fundamental education of new trainees to keeping experienced providers up to date, SCCM works to improve care through continuing education and hands-on skills training activities. Yet even in the United States, it is estimated that only 30% of all hospitals have trained intensivists (physicians specially trained in critical care medicine) available. We also educate patients, their families, and the public, and advocate in all forums to improve patient outcomes.

SCCM’s operations are divided into the following areas, which work collaboratively to achieve the overall mission in a cost-effective manner.

Research
Discovery, the Critical Care Research Network, is SCCM’s primary program supporting research-related activities. SCCM awarded its first pilot grant of $100,000 in 2018, under the auspices of the SCCM-Weil Research Trust. In addition, two $50,000 grants were awarded through the SCCM Weil-Research Trust for basic, translational, or clinical research. Examples of projects funded by SCCM are The Psychological Impact of Inter-ICU Transfers, Influence of Free Heme as a Red Blood Cell DAMP in Sepsis, and Breathing Efforts in Patients with ARDS.

Discovery held three clinical investigators meetings in 2018, one of them at the National Institutes of Health. Many new proposals were presented and given feedback, current Discovery programs were presented, and investigators networked with colleagues. Discovery now offers services and resources to assist in research, including data storage, management and analysis, a central institutional review board, project management, and communication services. In collaboration with SCCM’s Clinical Pharmacy and Pharmacology Section, Discovery launched a series of research webcasts. Funding Mechanisms in Critical Care Research was the final webcast of the year and focused on funding sources, including the federal government, foundations, and industry.

Recently, SCCM formed a Research Section, which promotes and supports all levels of research—from basic to clinical—relevant to the critical care community. It is a multiprofessional group of researchers that welcomes members from all disciplines. It supports the mission by encouraging critical care research in all forms and stimulates research and research collaboration. It works toward this vision through several activities and subcommittees, including Basic and Translational, Clinical and Epidemiology, Education and Simulation, Quality and Patient Safety, Mentorship, and Communications workgroups. These workgroups produce new Congress program submissions, connect junior researchers with established senior investigators, and produce a newsletter for section members.

Fundamentals
In order to address the lack of trained intensivists in the United States and globally, over 20 years ago SCCM launched the Fundamental Critical Care Support (FCCS) course, which prepares healthcare professionals to assess and manage critically ill patients in the first 24 hours of care. The course has since expanded to address multiple patient populations and topics. Produced in multiple languages, the Fundamentals program is used worldwide and includes five courses: FCCS, Pediatric FCCS (PFCCS), FCCS: Tropical Diseases, FCCS: Obstetrics, and Fundamental Disaster Management. In 2018, more than 20,000 healthcare professionals participated in Fundamentals courses, which were held in 38 countries across five continents. Courses were recently held for the first time in Nigeria, Panama, and Sierra Leone, where needs are most acute.

As maternal mortality rates continue to be a concern worldwide, SCCM is striving to educate intensivists and nonintensivists on the treatment of critically ill obstetric patients, with the 2018 launch of the FCCS: Obstetrics course. The course is designed to teach the basic concepts of how to respond, diagnose, and treat medical and obstetric processes in pregnant patients in need of critical care. Since its launch it has gained international interest and is scheduled to take place at sites across the globe.

To better meet the needs of patients, SCCM members and staff worked diligently to further expand the Fundamentals program through development of new courses on the care of surgical patients and pre-deployment training for military providers tasked with caring for critically ill patients in austere environments. The year 2018 also saw the release of the third edition of PFCCS, an update to the international course that provides effective training for providers treating the most vulnerable populations—infants and children.

Knowledge & Skills
The Knowledge and Skills business line is responsible for developing cutting-edge continuing education for trained critical care professionals to further advance their knowledge and skills, allowing them to make positive impacts on patient care. Educational programs in this area are the SCCM Critical Care Congress, Current Concepts in Critical Care, and Critical Care Ultrasound.

The SCCM Congress is the largest of the Society’s lineup of educational programs. The last two Congress meetings in San Antonio, Texas, and San Diego, California, have set records in terms of attendance and abstract submission. Details about Congress attendance can be found at sccm.org/AnnualReport.

Roundtable Discussions, which provided attendees the opportunity to network and discuss with peers a variety of professional development, career, and leadership topics. The new Tech Lab featured technology demonstrations, experiential learning, social media analysis, and Tech Talks about the latest and best technologies available to attendees in their personal and professional lives. Expanded Critical Crosstalk Theater programming included debates on current critical care topics, an interactive meeting with the editors of CCM and PCCM, and the first ever SCCM-wide quiz show competition.

To expand the reach of its hands-on ultrasound training courses, SCCM developed licensed courses with accompanying textbook and administrative materials—courses that were then held in Iran, Qatar, Spain, United Arab Emirates, and Japan. The Current Concepts course was also translated and held in China.

Review and Assessment
SCCM continues to expand its offerings of standardized, modular review and assessment activities to assist multiprofessional critical care providers in understanding their knowledge gaps, expanding their knowledge base, and preparing for certification.

In 2018, the updated Multiprofessional Critical Care Review Course was held in seven countries (United States, United Arab Emirates, Saudi Arabia, Korea, Japan, China, and Spain), educating more than 1,500 clinicians at this in-person live event.

SCCM self-assessment products offered more than 1,200 questions for both adult and pediatric clinicians while assisting nearly 900 participants in understanding their level of critical care knowledge. As more national board examinations move from the traditional 10-year examination cycle format to more frequent, open-resource assessments, self-assessment products continue to grow. SCCM continues to monitor the changes in critical care continuing education paradigms and respond with frequent updates and additional opportunities to test knowledge in mobile, online, and print milieus.

Overall, SCCM Review and Assessment programs were used by more than 3,600 individuals throughout the world in 2018.

Quality Improvement

SCCM seeks to improve the quality of care through the development and distribution of clinical practice guidelines and by working with groups of ICU providers on specific quality improvement collaborative projects to improve patient outcomes.

Clinical practice guidelines are systematically developed statements to assist healthcare practitioner and patient decisions about appropriate care for specific clinical circumstances. SCCM guidelines are developed by experts in the American College of Critical Care Medicine (ACCM). See more about ACCM in the Membership section below.

In 2018 SCCM released updated Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption. These guidelines, intended for adult patients, reveal the evidence that supported the 76-hospital collaborative implementing the complementary ABCDEF bundle components of SCCM’s ICU Liberation Campaign. The guidelines were translated into Spanish, Portuguese, and Japanese. The collaborative’s findings were published in CCM in the article “Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults.” This keystone paper validates the ABCDEF bundle’s association with lower likelihoods of hospital death, nextday mechanical ventilation, physical restraint use, ICU readmission, and discharge to a location other than home. Cost savings and harm reduction are primary findings. The guidelines, online learning program, website, book, and simulation course provide clinicians with the tools needed to implement the campaign in their ICUs. The ICU Liberation Committee is also developing a minimal dataset to be used for quality improvement and a bedside app to be released in 2019. Work in this critical area is ongoing.

Released in 2018 was part II of the joint SCCM/ESICM guideline, “Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part II), 2017,” addressing corticosteroid insufficiency, which can contribute to acute illness. Part I was released in 2017, providing a narrative review of the latest concepts and understanding of the pathophysiology of CIRCI. Also related to guidelines, the ACCM Board of Regents released a short instructional video on how to develop toolkits to facilitate better uptake of guidelines at the bedside and enhanced the standard operating procedure manual that provides detailed step-by-step guidance for leadership and panelist volunteers as they work on the complex guidelines process.

SCCM currently has 15 guidelines in the development process.

The Surviving Sepsis Campaign (SSC) released findings from the internationally focused research committee revealing the top six clinical priorities for sepsis research. The article on these findings, “Surviving Sepsis Campaign Research Priorities for Sepsis and Septic Shock,” was co-published in CCM and Intensive Care Medicine. The findings were presented at the ESICM meeting in Paris and SCCM’s annual Congress. SSC also released a Capstone paper, “Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda.” SCCM continues its collaboration with ESICM via the SSC on guidelines for recognition and treatment of sepsis and septic shock for children, with a release anticipated in late 2019. Since sepsis continues to be a devastating consequence of infection, SCCM has commissioned a task force to develop and disseminate a definition for sepsis in children and continues to consult with the World Health Organization on initiatives and policies to address this global health crisis.

The Ethics Committee continues to share poignant case studies through SCCM’s newsmagazine Critical Connections to support clinicians as they navigate complex ethical considerations related to the delivery of critical care. The Grenvik Family Award for Ethics recognizes a member in good standing who devotes significant efforts toward ethical problems in critical care and promotes humanistic and ethical values. The award is $1,000 cash, complementary Congress registration, and a recognition plaque.

In collaboration with the American Hospital Association’s Health Education Research Trust, SCCM continues its work on the reduction and elimination of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Because these infections can cause long-term harm and life-threatening conditions such as sepsis, SCCM serves on the national project team, and SCCM subject matter experts in CAUTI/CLABSI reduction conduct site visits to provide assessment and coaching on how to improve techniques, integrate teamwork, and activate key safety steps to prevent CAUTI/CLABSI. This quality improvement collaborative is funded by the Agency for Healthcare Quality and Research. Knowledge acquired from these activities are presented at the SCCM Congress and through SCCM communications vehicles to increase awareness.

SCCM partnered with the American College of Emergency Physicians to assess the incidence and impact of boarding critically ill patients in emergency departments when ICU beds are not available. The joint task force will provide a foundation paper and the two organizations will consider the findings for potential further action.

Patient & Family Support

SCCM provides information and resources to patients and their families about the ICU experience, including end-of-life issues. The MyICUCare.org website and the free Patient Communicator app—a tool to help ease communication between the patient, family, and caregivers in the ICU—are just some of the ways SCCM reaches out to patients and families.

In 2018 SCCM added a patient/family journal (sometimes called a diary) to the Patient Communicator app. Intensive care patients often remember little of their ICU stay because they are often sedated in the earlier stages of their illness. When they regain consciousness, it is common for them not to remember what happened; they may not know where they are or how ill they were. What they do remember are often delusional memories that can sometimes cause psychological difficulties and lead to forms of post-intensive care syndrome. The new journaling function lets family members, caregivers, and patients (when they are well enough) add entries throughout the ICU stay about the illness, dates and details of treatments, progress, and photos. These entries help patients’ recovery by giving them a better understanding of the time they spent in the ICU, fill in gaps of the time they lost in the ICU and help them see how much they have improved since the onset of their critical illness.

THRIVE ICU​
Every year, millions of Americans survive critical illness but, despite the efforts of their ICU care team, many are left with ongoing problems. The healthcare system often does not meet the needs of these survivors or their families during their weeks to years of post-ICU recovery. SCCM seeks to improve patient and family support after critical illness through the THRIVE Initiative.

Two international collaborative groups have been formed to work with caregivers and post-ICU patients to address this challenge. The Post-ICU Clinic Collaborative (19 sites, 3 outside the United States) fosters a network of hospitals focused on developing post-ICU clinics to provide comprehensive care to ICU survivors. Recipients share knowledge about how to set up and sustain a post-ICU clinic, and post-ICU patients benefit from caregivers who understand their needs.

The Peer Support Collaborative has 16 active sites (seven outside the United States) bringing together ICU survivors who can share their unique knowledge and skills with other survivors to help improve recovery. The THRIVE Initiative seeks to catalyze this sharing by creating an ICU survivor community. In face-to-face groups, survivors offer mutual support and share solutions related to ICU recovery. There are also social media-focused networks supporting patients and their families.

From these activities, SCCM is collecting data to better understand:

• What are barriers and facilitators to each different approach and specific model of post-ICU peer support and post-ICU clinic as well as sustainability?
• What do our patients and their families say works to improve post-ICU outcomes from peer support and postICU clinics?
• What does a successful program look like from the patient and family perspective?
• How can post-ICU services drive improvements in ICU care?

While SCCM has provided significant funding to develop these initiatives, it is also seeking external funding to support continued work in this area.

Membership
Joining SCCM as a member provides an opportunity for a multiprofessional critical care community to connect and work toward achievement of the organization’s mission. Together, SCCM members are impacting critical care across the globe through their voluntary efforts to develop and implement the programs described in this article. Anyone with an interest in critical care can join SCCM. Fellows in training receive free membership in SCCM when enrolled by their program director.

To meet the individual needs of a very diverse membership, in 2018 SCCM began offering a three-tiered membership structure that allows members to choose the tier that fits their current needs. As part of the new structure, the Select membership category receives expanded benefits. These benefits include early access to Congress registration and housing, free On Demand educational programs and products, and a special insider-edition newsletter with items of interest to our most engaged members. The Professional membership category, enjoyed by the bulk of SCCM members, provides the classic benefits of membership, including the CCM journal. The Associate membership category provides a streamlined membership opportunity for those seeking more limited services at a reduced cost.

Membership has also benefited from a new Diversity and Inclusion Committee, which has worked to identify opportunities to meet the diverse needs of our membership and has clearly defined the role of diversity and inclusion within SCCM by issuing a diversity statement, which is on our website.

Total SCCM membership remains at approximately 16,000, with 70% of members physicians, and the remaining 30% coming primarily from other healthcare professions such as nursing and pharmacy.

Donor Support​
In 2018, SCCM continued to expand and grow its donor development and stewardship program. Launched in 2017, this initiative focuses on expanding SCCM’s fundraising efforts to include grateful patients, family foundations, corporations, and others, as well as growing our traditional SCCM member donor base. Because of SCCM’s tax status, the organization can accept tax-deductible donations of cash, securities, and other assets to support its work.

The year 2018 was a successful fundraising year; we extend our thanks and appreciation for the financial generosity of our members, corporate partners, and family foundations who have provided support for our mission.

How Donations Were Used: In November 2017, your donations helped support SCCM’s Fundamentals training courses in Africa. Generous gifts helped send 20 faculty to the 2017 All Africa Anaesthesia Congress in Abuja, Nigeria, to teach six different Fundamentals courses. The courses attracted more than 200 participants from 54 African countries. This ambitious program would not have been possible without the generous support of many individual and corporate donors whose gifts helped cover the cost of travel for faculty as well as course materials and equipment for students.

In the fall of 2017 and again in 2018, SCCM responded to the urgent need for both medical and nonmedical items resulting from the devastation of Hurricanes Harvey, Maria, and Michael and the mass shooting in Las Vegas. Your generous gifts of both cash and supplies resulted in the collection of over 60 pallets of nonmedical supplies for PICUs and NICUs in hospitals in Puerto Rico. Additionally, special thanks go to Getinge and Hamilton Medical, who donated thousands of ventilator filters through SCCM to ship to Puerto Rico. These filters were essential in helping to keep critically ill patients ventilated in the aftermath of Hurricane Maria.

In 2018, SCCM held a public health fair titled Save-ALife, which provided members of the general public access to a wide range of educational and training activities in critical care. Most members of the public are unfamiliar with the ICU and common issues they or a loved one might encounter in the ICU. The program also provided hands-only CPR training in conjunction with local emergency medical services, SCCM member volunteers, and the Citizen CPR Foundation.

No Matter the Size, Your Gift Matters. Together, we can do so much more. In 2019 SCCM seeks to continue to expand its ability to provide disaster relief aid, support more critical care research, create better-trained and better-prepared healthcare providers in resource-limited areas, and support other vital SCCM programs. But to do more requires your support. We invite you to donate by simply clicking on the DONATE button at sccm.org or by going to sccm.org/donate and selecting a program and donation level that best meets your charitable goals. If you would like to discuss making a larger gift or developing an individual giving plan, please contact SCCM’s Chief Philanthropy Officer, Mark Lenhart, via email.

Finances​
Since its inception, SCCM has grown both in programs and financially. There have been steady increases in membership and Congress attendance, as well as growth in all other programs. The Council and staff leadership employ a conservative financial approach, putting aside resources into several reserve funds to support new program development and provide for emergency reserves. As a result, reserve funds grew to $23.4 million by fiscal year end 2018. Discovery and THRIVE are two new large programs that are currently being funded from reserves. SCCM also funds research from restricted funds set aside by the Council.

Over the past five years, SCCM has received over $2 million in grant support from private foundations and government agencies to support initiatives such as ICU Liberation, SSC, and Patient and Family Care. SCCM has an approved indirect cost rate of 36% from the Department of Health and Human Services, which is used to substantiate claims for indirect costs under grants and contracts awarded by the federal government, government agencies, and private foundations.

SCCM enjoyed another strong year of financial performance in fiscal 2018 with an overall net revenue of $3.3 million. Investment gains were very strong, accounting for $2.9 million of overall net revenue. Net revenue from operations was $380,000 on $18 million in gross operating revenue. The SCCM Statement of Position (balance sheet) is strong, with net assets of $29.6 million at fiscal year-end 2018. SCCM total assets reached $35.1 million, of which $4.7 million is property and equipment (net of depreciation). SCCM has no long-term debt. Audited financial statements are available for public inspection by contacting SCCM’s Chief Financial Officer Brian Schramm via email or at +1 847 827-6869.