Hello, and welcome to today's webcast entitled Survey Insights Referring and Receiving Patients with Sepsis. This webcast is funded by the Gordon and Betty Moore Foundation through a grant administered by the Council of Medical Specialty Societies. My name is Susan Lacey, and I'm the Associate Director of Research and Quality at the Society of Critical Care Medicine in Mount Prospect, Illinois, USA. I will be moderating today's webcast. A recording of this webcast will be available within five to seven business days. Log into mysccm.org, navigate to the My Learning tab, and click on Survey Insights Referring and Receiving Patients with Sepsis. Click on the Access button to access the recording. Thanks for joining us. Here are a few housekeeping items before we get started. There will be a Q&A at the end of the presentation. To submit questions throughout the presentation, type into the question box located on your control panel. Be sure to check out the companion podcast, which offers .25 hours of accredited continuing education. This content will be available this afternoon at 2 p.m. Central Time. Discovery has launched the Priorities for Research in Critical Illness Survey, PRECISE, an inclusive survey of all critical care stakeholders to identify critical care research priorities. The goal is to involve all critical illness and injury stakeholders. Please take five minutes to complete the survey and provide your feedback. Please note the disclaimer stating that this content to follow is for educational purposes only. And now I'd like to introduce your speaker for today. Dr. Greg Martin is Director and Pollen Professor of Medicine in Emory University, Atlanta, Georgia, USA. And now I'll turn things over to our speaker. Thank you very much, Susan, and welcome everyone to today's webinar. So I'm privileged to present this project that we did, and certainly a big thank you to the entire team that made that possible. Susan was one of those who, as you heard, was instrumental in receiving funding and working with our Council for Medical Specialty Societies, the CMSS, who has a strong interest in better understanding complex diseases and misdiagnoses, of which we'll talk a bit more about that. But also to one of the co-investigators, Christina Sifra at Boston Children's Hospital, who was a key element of this, has a lot of expertise in diagnostic errors and diagnostic dilemmas, and she's led a lot of the work in this as well. So I have the privilege of presenting the project for all of us together on the team. So let me go ahead and start moving forward. Our co-investigator that I just mentioned, the other one is Dan Woznika, who is one of our leaders at SCCM, who was also instrumental in putting together the elements. And one thing that I'll also talk about is some of the things that will grow from this project, and Dan was instrumental in putting those together so that we can help better inform and better care for our patients who are critically ill, particularly those with sepsis. So what you're going to see over the next several slides is a survey of better understanding how clinicians, particularly sort of receiving and referring clinicians, receive or give feedback about particularly focused on patients with sepsis. So the purpose of this survey overall was to better understand feedback mechanisms and what feedback was usually sort of under traditional mechanisms or what's happening now for if you're a receiving physician or clinician, meaning you would receive a patient with sepsis into your ICU or into your critical care space, or you're a referring physician, meaning you may be working in an ED or in a ward or in a post-operative care unit where a patient is being admitted from that space, you're transferring that patient or admitting that patient from that space to an ICU or to another area for sepsis care. So we have a variety of people together that are a part of that survey, and what you see here on this slide is the mixture of professionals that are part of that team. So about 62% of the respondents are physicians, but we have a good representation of other care providers, both in the ICUs and in other environments, including advanced practice providers and over 20% of other care professionals, including pharmacists and others. And then the mixture of where these people work, so again, thinking of our focus of critically ill patients and focusing on patients who would most often encounter the providers who are caring for patients with sepsis, about 70% of those were people who worked at least most of their time in an ICU, but as you see, there's also a mixture of other people, including other hospital wards, including the emergency departments and even some outpatient specialty areas where patients may be admitted, for instance, in complex care clinics and oncology clinics where patients may be admitted with sepsis. And then finally, the specialties that people trained in, so again, about 69% of the respondents to the survey were particularly focused in critical care medicine, but we also had a mixture of other people, including about 15% who were emergency medicine and other backgrounds as well. And you'll notice that this does not add up to 100% because of the 529 survey respondents, many of them were jointly trained, so for instance, in pediatric critical care or in pulmonary critical care very commonly. So the first part of what I'm going to discuss is the feedback from receiving clinicians, so these would most often be the people who are often in an ICU who are receiving an admission of a patient with sepsis and understanding from them more about feedback opportunities and how that works. So of this group, there are 433 respondents who were receiving clinicians, particularly focused on patients with sepsis. So of those 433 people, what you see here is the frequency with which they would receive patients with sepsis, and what's particularly remarkable to me is that of those latter two pieces, over 21 to 30 or more than 30, meaning put those together, about 35% are pretty high volume sepsis hospitals or ICUs, so receiving admissions, more than 20 patients per month of sepsis, so it's obviously a common diagnosis, but it's also commonly represented in the people who are surveyed. And then the next question was about how when patients were referred or admitted to them with sepsis, what was the clinical condition, and as you might imagine, many of them were critically ill, so particularly in that what you see in the first row, 46% were extremely ill, meaning they needed immediate life-sustaining interventions. Another 42% were acutely ill but were reasonably stable and had time to do some other work to try and stabilize them, and then a smaller percentage were moderately ill or less ill, meaning that they had been stabilized already or didn't need an acute intervention or maybe it had been stabilized with other interventions prior to admission to the ICU. Now we get to the feedback part, and this is, I think, maybe the core of what we were trying to understand, so here we have the receiving clinicians, those 433 people, and how often they gave feedback to the referring clinicians, meaning the unit or the department that was sending those patients to them, so if they were coming from an emergency department, from a hospital ward, from another place in the hospital or the clinics. And what you see here is that about 25% sometimes relayed feedback, 23% seldom, but 14% never gave any feedback, and then the other two groups, which are relatively small, 22% and 15% often or always, so what's remarkable here is that it really, it's the entire spectrum of feedback of how often it's given, but maybe not surprisingly to people who are used to clinical environments and even caring for critically ill patients and working in an emergency department, it's not common that feedback is given or it's certainly not given consistently, so that's what's reflected here is that seldom, never, and sometimes are some of the most common ones when you put those together. And then the next question we asked was how would you, what do you think is the best way to relay that feedback, and so for the receiving clinicians, they felt that the best way to do that was via telephone, so you can imagine if you're the patient, if you're the provider receiving a patient with sepsis, you may feel that the best way to share that feedback, particularly if there's any urgency to it, would be via telephone. The next most common mechanism was electronic health record, where about 35% of people felt like that was using an inbox messaging system electronically would be the next best way to relay that feedback. We asked about several other potential mechanisms that people might use, including email or even other forms of doing it, including regular mail, and they were not surprisingly less common, but you also, when we talk about the referring clinicians, those who are sending or admitting those patients with sepsis to the receiving clinicians, we'll see how they think about how to relay or receive feedback as well. Then the next question we asked was what's the ideal time to do that, meaning sort of when during the course of a patient's illness would be the right time to relay that feedback, and most people felt, about 35%, that the feedback would be best suited to be given once at some time during the patient's admission, other than that admitting day. The next most common, 25% felt like that admitting day was the best time to do it, so it still may be one time, but it would be relatively acutely, meaning doing it on the day of admission, and then other people felt that, so about 23% felt like multiple times would be really helpful, and about 14% said that they felt like the right time would be when the patient is being discharged from the hospital or at least discharged from the ICU, meaning that they had sort of seen the more full course of the illness so that they could relay information. So here you see sort of, again, a broad spectrum, but many people felt like one time feedback was perhaps useful, and then the question was would it be sometime during that ICU admission or would it be relatively urgent, meaning doing it on the day of admission. Now the other questions we asked about for these receiving clinicians was how often had they relayed feedback and how often were they doing that now at baseline, and what you see here is about 45% had done that about one time, so again, you know, one time during the admission they felt like they were giving some feedback back to that referring or admitting admission. 37% or 38% felt like they were doing that as well, but really just one time on the day of admission, so that may be part of the normal handoff and particularly feedback of the urgency if you're evaluating the patient once they arrive to your unit and you're providing some feedback about the patient and their condition. And then the other two things that we talked about on the last slide, about 28% did it more at discharge, so at the time that the patient had completed their course in the ICU or the hospital, and then about 25% actually did it pretty commonly, so about 25% actually did multiple feedback sessions or feedback loops during the patient's admission. And then the next thing for receiving clinicians was asking them more about what information were they able to relay, so what were the things that they might be able to share, and this is, again, not going to add up to 100% because people could tick off mini boxes of all the things that they might be able to relay. These are not the things that they always do, but what would they be able to relay, and a lot of it is about the patient's current condition, the diagnosis, particularly if it may have changed or something new was discovered. And then the other one that we certainly wanted to learn more about, 62% of people felt like there was opportunities for improvement in diagnosis or management, so, you know, what else might have been done either acutely in that early initial evaluation and triage process or sort of early, had to be done early in the phase of the patient's course in the ICU. And then other things like what procedures were done, what other consultants may have become involved in care to help, I think, flesh out a little bit more of what maybe could have been done earlier, but at least back to the referring clinician, what else needed to be done to help care for that patient after arrival into the ICU with sepsis. And now the next question is, what feedback did they typically relay? So the last slide was about what were they able to relay. This is actually more about what did they routinely do, and a lot of this is similar, so most often it was about the primary diagnosis, the patient's current condition, those were the most common things when people were relaying feedback that they did convey back to that referring physician. They often would then also include things about opportunities for improvement in management, but then the other things that we just talked about, what procedures, what consultants and other things, including ultimately what was the disposition of the patient and how did they do during their course in the hospital or the ICU. So all of that, again, were all frequent elements, and they really match what you were able to do, and that's really the kinds of things that people routinely were doing in their clinical practice. Now the next element is now, do you want to relay feedback to that referring after transfer or after admission to you? So here of the 433 people, we have really 68 to 70% of people saying yes, they really do want to relay feedback. So we saw earlier that feedback was not that often relayed, so in fact there were a large percentage of providers who didn't routinely provide feedback, but a lot of them were saying, yes, I'd like to be able to do that. I felt like that might be important to the referring clinicians, and in fact only 4% said that they really didn't want to relay that kind of feedback to the referring team or provider. And then finally, based on your experience of receiving patients, what would be the most important thing for education? So if you're trying to provide feedback that would educate the referring clinicians that may improve the care of the sepsis patients, the first and most common was 52% saying that they felt like resuscitation and stabilization of patients, particularly for the early signs of sepsis. So that may be hemodynamic or respiratory support, two of the more common things that we see in sepsis and often are reasons for admission to an ICU, and how do we, making sure that that feedback was given back in case, particularly if there were things that maybe could have been done or done differently early in the course of illness from the admitting unit before they arrived to the ICU. The other one, the next most common one, again, not surprisingly, and this gets back to how difficult sepsis may be to diagnose, but about 28% of the receiving clinicians felt that feedback about, educational feedback about recognizing the signs and symptoms of sepsis would be helpful or would be something they would like to be able to relay more about. And many hospitals have taken on or created sepsis surveillance and screening initiatives and entire processes and protocols for helping to identify those patients and manage them acutely. But still this represents, if there's 28% of receiving physicians or clinicians who still feel that that's an opportunity, it tells us that even in large volume hospitals where, again, more than 20 to 30 plus sepsis admissions per month are occurring in a lot of these providers, tells us that it's in fact very common and this is still an opportunity for improvement. And then finally, the last one was information to be communicated to you about the patient. So after receiving the patient into the ICU, for instance, what information may have been missing or may have not been communicated clearly, or may have been not prioritized, those are the kinds of things that maybe would have made a difference upon arrival of that patient that you weren't aware of when you received the handoff or the communication about the patient being admitted and transferred to you. So those are the major things that receiving clinicians felt like they would like to try and improve both through feedback and improve the education and care of patients. So now let's pivot and talk about the other side of the survey. So we talked first about receiving clinicians and healthcare professionals who were receiving patients being admitted with sepsis. Now let's talk more about the referring clinicians. So of this, there were 96 respondents. And we asked many of the same kinds of questions. So of the 96 respondents, the first question, again, was how many patients per sepsis do you or your unit manage and admit per month? And what you see here is representative much more of a non-ICU population, but much more of an ED or hospital ward population. So here, the most common response was 0 to 10. So 69% of respondents only had 0 to 10 sepsis patients transferred per month. That would certainly be common for a hospital ward provider, a hospitalist, for example, where most of their patients are on the ward, and they do fine on the ward, and they aren't transferred to an ICU for sepsis. And even in an ED where the total volume of patients is quite large, but the number of patients with sepsis ends up because of that large denominator being a smaller percentage. So this is not surprising, but still you're seeing a substantial number of sepsis. In fact, 15% of the respondents were still admitting more than 30 sepsis patients per month. So there's a wide variety of respondents here to help us understand the referring clinician perspective. Now, the next one was sort of the timeliness of sepsis and communicating that admission and transfer process. So the question was, how often do you contact an ICU referral center within six hours of arrival of a patient to your unit? So for instance, if a patient comes into the ED and they're going to be ultimately admitted to an ICU, how often is it that you're able to make that referral within six hours of arrival? About 30% felt like they could do that often. Another 26% felt like they did it always. But what you see is in the sometimes, seldom, and never is still quite a large percentage. So these are subjective and it represents the perception of the referring clinician of the timeliness of their care, but you still see certainly an opportunity for more timely identification and referring that patient as quickly as possible. Or if we're thinking about how do we manage that patient between an ED and an ICU and making it as seamless as possible, how do we make sure that the interventions and the acute management of that patient occurs so that when they are transferred to the ICU, much of their initial care, particularly the time-sensitive care, has been done and that handoff makes it easier for the patient as well. The next question was about what drives that admission. So meaning what symptoms, tests, or other things would contribute to your decision to refer or admit a patient to an ICU? And not surprisingly, about 79, 80 to 85% of times, it was things that really drive the need for critical care, the development of critical illness like organ dysfunction, the presence of respiratory failure and need for respiratory support or shock and the need for management of septic shock. The other most common were things like vital signs, so particularly abnormalities of heart rate, fever, and respiratory rate, and then lab results, elevations or abnormalities of lactate, creatinine, and bilirubin. Now again, these add up to more than 100% because those may coexist and often would. You can imagine patients who have respiratory failure or shock may also have elevated respiratory rate, heart rate, lactate, and creatinine. So what we're looking at here is probably the most common thing that drives that referring clinician to admit a patient into an ICU is all these things together. But organ dysfunction, not surprisingly, would be one of those that's most often apparent even early in the phase, meaning sort of when a patient is in an ED. If those are present, they're going to be clinically evident, and it's going to drive the determination or the reason to admit a patient to an ICU. Less commonly was things like a sepsis screening tool, so for instance, using a SOFA score or an early warning system score, MUSE or NUSE, to try and use that as a clinical tool to determine when a patient needs to be admitted to an ICU. That was still used about 48% of the time, but again, that may well overlap or coexist with the other thing. So that might have been part of the information that was given, but less often was used as really the determining factor for admitting a patient to an ICU. And the next was asking more about feedback, so now pivoting and talking about the feedback for these referring clinicians. The question was, over the past year, how often did you receive feedback about a patient and the care that you had admitted to an ICU or to another care space in the hospital for sepsis? So this is really interesting because what you see here on the right-hand side is a full spectrum of everything from always to never, representing actually a pretty broad array, so between 15% and 22%, meaning it's really completely spread among each of those five categories. So if you look at that optimistically, there's about 43% or 44% of referring clinicians who are... Sorry, there's about 42% of referring clinicians who are receiving feedback either always or often. But on the flip side, there's about 60% who are seldom, sometimes or never receiving feedback about the patients that they're admitting with sepsis. And that, again, represents both an educational opportunity, but certainly a clinical opportunity for developing systems and providing feedback, as we've heard, at least from the receiving clinician perspective, they wanted to be able to do that more often and they were seeking ways to try and improve the care of patients by using feedback mechanisms. Now, we asked some of the same questions of these referring clinicians. So the question here is, what's the best way to receive that feedback from the receiving unit clinician? So they felt like the most effective way for them would be EPIC, not necessarily EPIC, but electronic health record messaging. So using the electronic systems or our EHRs to convey information back to them as the referring clinician so that they would get that feedback. Now remember, this is a little bit different because the receiving clinicians most often felt that the best way to do it was via telephone and 40 or so percent of receiving clinicians and that was often what they were doing. But now on the referring clinician perspective, they're feeling more often that using an electronic digital medium might actually be more effective for them. And that may represent the fact that in the broad array of patients that they're managing, there's perhaps a smaller percentage that are sepsis or maybe they felt like the diagnosis was more clear and they don't feel like the feedback was necessary. But on the other hand, they also have their shift in their time. And so calling them, particularly if it's the end of their shift and that you may not reach them. So they may be looking at it from a logistic perspective and saying, telephone may not work for me if I'm not in the hospital or still working at that time. So they're thinking that using digital tools like the EHR system might be a more effective way to receive that kind of feedback from the receiving unit. Then the next question is what kind of feedback, what type of feedback from the receiving physician would be helpful? And what you see at the top, 77% felt like they really wanted to know opportunities for improving the diagnosis or the management of the patient. So once they were into the referring, into the receiving unit, what should the referring unit have done differently, meaning what in the ED, for instance, might've been done differently to facilitate the care of that patient. Then other things that they felt like they would like to know is what was the primary diagnosis? Were there other diagnoses that occurred during the course of illness or the course of care in the ICU? And then finally, some of the same things that we saw from the receiving clinicians, things like what procedures did the patient require? What other consultants were involved in the care? Because those are the kinds of things you can imagine they would look at and say, oh, well, maybe that's the kind of thing, had I known that or been able to detect that earlier, then maybe I would've gotten those people involved or done those procedures earlier and facilitated the care of the patient. This also gets back to, recall that of the receiving clinicians, it was very common for patients to arrive into the ICU needing relatively acute intervention. So that was really, really common. And that may also reflect a communication element here of, are there things that either consultants or procedures or other diagnoses that maybe need to be considered or done by the referring team in the process of facilitating care? So that was what we saw from the receiving team. The referring clinician in some ways is saying, what else did we miss? What are the other things that I should have known? What are the opportunities for improvement? And how do I do that better in my work environment? Now, the next question was sort of how often are they receiving feedback and particularly are they satisfied with the feedback that they're getting? And what you see here, the most common answer, 55% said that they agreed. If you add in the strongly agree, you end up with about 70%, a little over 70% who agree or strongly agree that they're satisfied with the feedback that they're getting. Now, this is interesting because the last slide did very clearly say that they wanted to hear more. And particularly, these are the things that they wanted to hear about, about opportunities for improvement and being able to better understand the diagnoses and the procedures and the consultants involved in the care of those patients. It was relatively uncommon. In fact, only 8% strongly disagreed with the satisfaction with feedback, meaning that they felt like they were satisfied and didn't feel like there was anything that necessarily needed to change, or that they did feel like there were things that definitely needed to change. And then the next question for our referring clinicians was the types of feedback that they had received. So, and again, this gets to, this again adds up to more than 100% because the questions are allowed to be answered of all the things that you might want to receive as in terms of feedback. What are the kinds of things that you've typically received? So the most common answer to that was the opportunities for improvement, meaning the receiving clinician was often sharing that information back most commonly. What are the things that could have been done differently or what perhaps was not so apparent in the emergency department or the early care space about the diagnosis and management of that patient that was then discovered or uncovered once the patient was received into the referring unit. Then the other ones are the same things that we've seen on some of the other slides. We framed and asked these the same way. So what are the primary diagnoses? What was the patient's current condition? What other procedures, what other consultants were involved? And also what was the ultimate disposition? So again, getting at sort of how did the overall care of that patient go, 44% of patients really did say that they liked to receive or they were receiving that kind of feedback about the care of patients. So overall, I think the way we think about this is thinking about how do we take all that information and put that together into a way that we can facilitate better care of patients. And again, focusing on sepsis, and I'll come back to why that's still perhaps most important, but allowing us to take these tools and to develop toolkits and other mechanisms that we can provide information and facilitate feedback that goes across care environments, from an ED to an ICU, for example, so that the patients will get better care and the providers are better educated. Some of the things you saw in here are a little bit striking because we certainly saw opportunities where there were certainly elements where both receiving and referring clinicians of patients with sepsis felt like there was the opportunity or desire for having more feedback and better understanding the care of the patient. What were the diagnoses? What was the condition of the patient upon arrival to the ICU, for instance? And I think, everyone, what we also saw in general was a desire to improve the care of the patients, both individually as a clinician, they wanted to improve their care, but they were also interested in how do we do that, like what are the best mechanisms for creating that? So when we think about this, we now can take this information from this survey and think about how do we apply that to other tools that we can use, whether it's electronic health records or other tools for sharing this information forward and creating ways to better do the care, the early care and the transfer of patients with sepsis. So with that, I will stop and hand it back to Susan, and we'll go through questions and answers and hopefully the audience has other things to ask about this. Thank you, Dr. Martin. Just a few questions. Why were you and your team interested on how referring and receiving clinicians communicate about patients with sepsis? What was the impetus for the study? That's a really good question, Susan. So there's really two parts to that. The first is the focus on sepsis, and for that, we know that sepsis is very complex and it's one of the most frequent missed diagnoses, meaning it's a diagnosis that's missed, but it's also one of the most frequent misdiagnoses, meaning it's a diagnosis that is given a different name or the wrong diagnosis is attached to that patient. So that makes it a diagnostic dilemma or a diagnostic challenge, and there's a lot of diagnostic errors that occur in sepsis, particularly because of the challenge of identifying the condition at an early time when interventions need to be made. And we all recognize, certainly as clinicians, we recognize that sepsis often masquerades as another condition, which does make it exceedingly difficult to diagnose. So when we think about ways to better integrate the care of those patients, because they do start in one care environment and often move through two, three, or four other care environments during a hospital stay, how do we improve the care of that patient, particularly for a complex diagnosis like this, and make sure that we have a way of creating tools that actually facilitate that care? So that gets back to, why do we want to understand referring and receiving clinicians? Because sepsis is sort of the quintessential diagnosis where time-sensitive care is important, meaning we need to identify that patient quickly and in a timely manner, and then we need to initiate care in the same timely manner. But in that process, we have the opportunity for better understanding as patients then make that transition from one care environment to another. What are the things each group understands, and particularly, how do we assess that? So the survey was intended to assess the referring and the receiving clinicians, and sort of the way they think about the communication and feedback they're receiving, so we can begin to think more about, what are the opportunities for improvement? Sepsis is complex, it's often misdiagnosed, but at the same time, how do we now link that to what clinicians are doing and receiving, so that we can think about how to develop tools that will actually make that easier and better for them as well? Thank you. Were there results that surprised you? Definitely were, and it's probably true of most surveys, that there's often something in there that jumps out at us. And I think in this case, the thing that was both surprising and not surprising, the not surprising part is that feedback is not often given or received. And that's one that is known from prior literature, and I think we all recognize that if we're clinicians working in a healthcare environment, we recognize that we're busy, and we often feel like we're focusing on our domain or our space where we work, and we may not always think about the outside elements, and how do we think broadly as a team? And even though critical care is the quintessential team sport, particularly in the ICU, the referring physicians, meaning the clinicians who are sending patients into the ICU, we don't often have as many mechanisms or consistency of sharing that back. So on one hand, it was not surprising that feedback was not often given, because we knew that from healthcare in general. What was surprising though, is on one hand, many of the referring physicians felt like they were giving or receiving feedback as often as they felt like they needed it. But on the other hand, the receiving clinicians felt like they were giving feedback, but really would like to be able to give more, and they felt like there were opportunities for improvement there. So there's a bit of a mismatch there. And that's where thinking about the mechanisms, do we do that through the electronic health record? Do we do that by phone? Do we do that via email? And each system might be different there. So jumping forward to sort of what do we do with this? One of the things is, how do we provide feedback and how do we make that work in any care environment? So we've spoke a lot about probably the most common, which is a patient with sepsis being identified in an emergency department, then being admitted into an ICU, and we have a receiving and a referring clinician that are on each end of that. But there's a variety of other mixtures in that, and each health system is different and each electronic health record is different in the way that they do messages, or even the team that's involved. If you have a sepsis team in your hospital, they may be a core element for creating and sharing feedback and doing process improvement. So of all the things that we see, we think the survey tells us that there is an opportunity or a desire to share more feedback, which might be more connectivity across those systems, but then how do we do that and what are the tools that we need to use to do that flexibly and effectively across different health systems? Right. So what are your final thoughts, given your study results? I guess there's, I mean, the main thing to me is, one, is that we certainly have the opportunity for improving the care of patients with sepsis. So the survey very clearly told us that, yes, we have a lot of people in particularly high volume centers who are admitting and caring for a lot of sepsis patients. Feedback is not consistently being given, and there's definitely an opportunity for better educating and improving the care of patients and better connecting that care by using feedback mechanisms. And I think as we've moved into a more digital era with use of electronic health record systems, there are platforms that we can use to make that hopefully easy and effective. The other part of that, too, is we need to make sure that what we're giving is specific feedback that's solution-focused and is positive and consistent and can be done well, meaning that the information that we're feeding back is both educational and actionable, so that it's not considered punitive, it's not considered critical. It's more constructive to say, we're all trying to care for the same patient and provide the best outcome. Here are things that we as a system can do better. And so that's why I think when we're thinking about mechanisms to create and share feedback, a lot of that would be about creating the flexible systems like using an electronic health record system, for instance, to do that, but making sure that we're doing is providing actionable information to the clinician and to the system so that they can actually use that for their individual practice and for the next sepsis patient that they would see in their environment. Well, thank you, Dr. Martin, for your time and working on the survey with the other investigators. We really appreciate your time. Well, thank you, Susan, and thanks for everyone for being here. It's definitely a team project, and I appreciate all the work of everyone. It's my privilege to present for what the team did. And thank you to the audience for attending. Again, this webcast is being recorded. The recording will be available to registered attendees within five to seven business days. Log into mysccm.org, navigate to My Learning tab, and click on Survey Insights, Referring and Receiving Patients with Sepsis. Click on the Access button to access the recording. And remember to check out the companion podcast on the SCCM Diagnostic Excellence Program page. This content will be available this afternoon at 2 p.m. Central Time and offers .25 hours of accredited continuing education. Also keep an eye out for the resources which we have available on the SCCM Diagnostic Excellence Program page. That includes our presentation today.

sepsis

clinicians

feedback mechanisms

patient outcomes

communication

survey insights

digital tools

education