title: Canadian Association of Emergency Physicians sepsis treatment checklist: optimizing sepsis care in Canadian emergency departments.
abstract: OBJECTIVE
  The Canadian Association of Emergency Physicians (CAEP) sepsis guidelines created by the CAEP Critical Care Practice Committee (C4) and published in the Canadian Journal of Emergency Medicine (CJEM) form the most definitive publication on Canadian emergency department (ED) sepsis care to date. Our intention was to identify which of the care items in this document are specifically necessary in the ED and then to provide these items in a tiered checklist that can be used by any Canadian ED practitioner.
  
  
  METHODS
  Practice points from the CJEM sepsis publication were identified to create a practice point list. Members of C4 then used a Delphi technique consensus process over May to October 2009 via e-mail to create a tiered checklist of sepsis care items that can or could be completed in a Canadian ED when caring for the septic shock patient. This checklist was then assessed for use by a survey of ED practitioners from varying backgrounds (rural ED, community ED, tertiary ED) from July to October 2010.
  
  
  RESULTS
  Twenty sepsis care items were identified in the CAEP sepsis guidelines. Fifteen items were felt to be necessary for ED care. Two levels of checklists were then created that can be used in a Canadian ED. Most ED physicians in community and tertiary care centres could complete all parts of the level I sepsis checklist. Rural centres often struggle with the ability to obtain lactate values and central venous access. Many items of the level II sepsis checklist could not be completed outside the tertiary care centre ED.
  
  
  CONCLUSIONS
  Sepsis care continues to be an integral and major part of the ED domain. Practice points for sepsis care that require specialized monitoring and invasive techniques are often limited to larger tertiary care EDs and, although heavily emphasized by many medical bodies, cannot be reasonably expected in all centres. When the resources of a centre limit patient care, transfer may be required.
authors.affiliation: Walter MacKenzie Health Sciences Centre, Edmonton, Canada. djogovic@ualberta.ca
authors.forename: Dennis
authors.initials: D
authors.lastname: Djogovic
authors.forename: Robert
authors.initials: R
authors.lastname: Green
authors.forename: Robert
authors.initials: R
authors.lastname: Keyes
authors.forename: Sara
authors.initials: S
authors.lastname: Gray
authors.forename: Robert
authors.initials: R
authors.lastname: Stenstrom
authors.forename: David
authors.initials: D
authors.lastname: Sweet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davidow
authors.forename: Edward
authors.initials: E
authors.lastname: Patterson
authors.forename: David
authors.initials: D
authors.lastname: Easton
authors.forename: Shavaun
authors.initials: S
authors.lastname: MacDonald
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gaudet
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kolber
authors.forename: David
authors.initials: D
authors.lastname: Lechelt
authors.forename: Daniel
authors.initials: D
authors.lastname: Howes
mesh_terms: D002170:Canada; D057189:Checklist / Q000592:standards*; D003697:Delphi Technique; D004635:Emergency Medicine / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012955:Societies, Medical; D017749:Total Quality Management; D016896:Treatment Outcome