WEBVTT 00:00:00.400 --> 00:00:02.640 So, without further ado, I'd like to introduce 00:00:02.640 --> 00:00:05.120 our first session of the day, which is entitled 00:00:05.120 --> 00:00:07.639 Defining and Innovating Strategies. And we have 00:00:07.639 --> 00:00:09.339 the pleasure of kicking off today with a live 00:00:09.339 --> 00:00:12.599 viewing of the Canadian Breakpoint podcast, hosted 00:00:12.599 --> 00:00:15.560 by Dr. Rupina Purwal. This podcast is designed 00:00:15.560 --> 00:00:17.739 to create awareness of increasing AMR and our 00:00:17.739 --> 00:00:20.059 fight against it, to focus on discussions around 00:00:20.059 --> 00:00:22.780 new diagnostic methods, how to implement technology 00:00:22.780 --> 00:00:25.179 in clinical and laboratory medicine, and review 00:00:25.179 --> 00:00:27.899 emerging infectious diseases. The title of this 00:00:27.899 --> 00:00:30.920 episode is Canadian Sepsis Strategies, Optimizing 00:00:30.920 --> 00:00:32.979 Patient Management with Antimicrobial Stewardship. 00:00:34.179 --> 00:00:36.560 Dr. Purewell is a pediatric infectious disease 00:00:36.560 --> 00:00:38.840 physician. She was born and raised in Edmonton, 00:00:38.840 --> 00:00:40.740 Alberta, and completed her medical school at 00:00:40.740 --> 00:00:43.140 the University of H in Hungary. I did have to 00:00:43.140 --> 00:00:44.679 look up how to say that. It is not spelled that 00:00:44.679 --> 00:00:47.840 way. Thereafter, she moved to the United States 00:00:47.840 --> 00:00:50.100 for a three -year pediatric residency program 00:00:50.100 --> 00:00:53.439 at West Virginia University. She returned to 00:00:53.439 --> 00:00:55.920 Canada in 2017 to start her Pediatric Infectious 00:00:55.920 --> 00:00:58.039 Disease Fellowship at the University of Manitoba. 00:00:58.579 --> 00:01:00.759 Dr. Pirol has been working in Saskatchewan since 00:01:00.759 --> 00:01:03.380 2019 as a clinician and academic physician at 00:01:03.380 --> 00:01:06.560 the University of Saskatchewan. On today's episode, 00:01:06.680 --> 00:01:08.359 she will be hosting two members of the National 00:01:08.359 --> 00:01:10.879 Sepsis Action Plan, Dr. Kelly Barrett and Fatima 00:01:10.879 --> 00:01:13.799 Sheikh. Dr. Barrett has an M .D. from the Schulich 00:01:13.799 --> 00:01:15.420 School of Medicine at the University of Western 00:01:15.420 --> 00:01:17.420 Ontario and completed her training in internal 00:01:17.420 --> 00:01:19.900 medicine and adult critical care medicine at 00:01:19.900 --> 00:01:22.230 the University of Toronto. She is presently the 00:01:22.230 --> 00:01:24.090 medical director of the Recover Home Ventilation 00:01:24.090 --> 00:01:26.769 Program at the Toronto Grace Health Centre and 00:01:26.769 --> 00:01:29.329 is an affiliate scientist with the Health Systems 00:01:29.329 --> 00:01:31.370 and Policy Research Collaborative Centre at the 00:01:31.370 --> 00:01:33.810 University Health Network. Her academic work 00:01:33.810 --> 00:01:36.030 focuses on evidence to inform policy development. 00:01:36.689 --> 00:01:38.890 She has real -world experience in this regard 00:01:38.890 --> 00:01:40.750 in Ontario and is presently in her fourth term 00:01:40.750 --> 00:01:42.269 as a member of the Ontario Health Technology 00:01:42.269 --> 00:01:44.489 Advisory Committee at Ontario Health, and she 00:01:44.489 --> 00:01:46.250 sits on several working groups with the Ontario 00:01:46.250 --> 00:01:50.060 Provincial Long -Term Ventilation Strategy. Fatima 00:01:50.060 --> 00:01:52.620 Sheikh is a PhD candidate at McMaster University 00:01:52.620 --> 00:01:55.060 and a Canadian researcher focused on health equity 00:01:55.060 --> 00:01:58.060 and the social determinants of health. Her research 00:01:58.060 --> 00:02:00.319 focuses on understanding how social determinants 00:02:00.319 --> 00:02:02.739 of health influence both the incidence and outcomes 00:02:02.739 --> 00:02:05.760 of critical illnesses. She also explores how 00:02:05.760 --> 00:02:07.299 these determinants shape healthcare delivery 00:02:07.299 --> 00:02:09.659 with a goal of informing equitable health policies, 00:02:09.919 --> 00:02:11.879 responsible evidence use, and inclusive care 00:02:11.879 --> 00:02:14.610 practices. In addition to her academic work, 00:02:14.669 --> 00:02:16.610 Fatima holds a role in equity, diversity, and 00:02:16.610 --> 00:02:19.069 inclusion and human rights department at Hamilton 00:02:19.069 --> 00:02:21.449 Health Sciences. And in this role, she leads 00:02:21.449 --> 00:02:23.389 collaborative initiatives with communities, patients, 00:02:23.629 --> 00:02:25.909 and regional partners to design and implement 00:02:25.909 --> 00:02:28.210 processes for collecting social demographic data 00:02:28.210 --> 00:02:31.210 and advancing equity, inclusion, and anti -racism 00:02:31.210 --> 00:02:33.990 across the organization. So please welcome them 00:02:33.990 --> 00:03:01.099 to the stand. Welcome everyone to another episode 00:03:01.099 --> 00:03:03.439 of our podcast, The Canadian Breakpoint. Thank 00:03:03.439 --> 00:03:07.199 you so much for tuning in. It's my pleasure to 00:03:07.199 --> 00:03:11.340 be here today to actually come for the second 00:03:11.340 --> 00:03:14.719 time and do a live podcast. And for our listeners 00:03:14.719 --> 00:03:19.300 that are tuning in virtually, welcome as well. 00:03:19.419 --> 00:03:23.240 And thank you to our guest speakers today. So 00:03:23.240 --> 00:03:24.840 today we're going to be talking about a really 00:03:24.840 --> 00:03:29.280 important topic and it's regarding sepsis. So 00:03:29.280 --> 00:03:34.080 before I begin, I wanted to get a poll from the 00:03:34.080 --> 00:03:39.360 audience to see kind of what we know about sepsis 00:03:39.360 --> 00:03:44.800 and those that have encountered someone with 00:03:44.800 --> 00:03:49.319 sepsis. So I don't have my ticker up here. I 00:03:49.319 --> 00:03:54.319 have to advance the slide. Okay, so I think some 00:03:54.319 --> 00:03:57.879 of you guys know how to enter into Slido. So 00:03:57.879 --> 00:04:00.819 you can either use the QR code there or through 00:04:00.819 --> 00:04:06.240 the app itself. And so the first question is, 00:04:06.280 --> 00:04:12.819 what is sepsis? Perfect. Looks like everybody 00:04:12.819 --> 00:04:32.050 pulled in. Okay, I think we'll close that poll. 00:04:32.110 --> 00:04:35.689 So I think the majority of our listeners today 00:04:35.689 --> 00:04:40.670 realize that it is an organ damage produced by 00:04:40.670 --> 00:04:43.389 inappropriate inflammatory response to infection. 00:04:44.069 --> 00:04:49.110 So that's a correct answer. Next question. So 00:04:49.110 --> 00:04:52.550 which of the following of these is a sepsis warning? 00:05:10.079 --> 00:05:13.939 Okay, perfect. So yes, all of the above would 00:05:13.939 --> 00:05:18.519 be, thank you. All right, and then we'll talk 00:05:18.519 --> 00:05:21.699 to Dr. Barrett more about elaborating on some 00:05:21.699 --> 00:05:30.319 of those warning signs as well. Okay, and then 00:05:30.319 --> 00:05:33.319 our last question is, has someone, so either 00:05:33.319 --> 00:05:37.120 in this room or any of our online listeners, 00:05:37.480 --> 00:05:40.060 has anyone in your life? like a close friend 00:05:40.060 --> 00:05:48.540 or family member gone through sepsis? And so 00:05:48.540 --> 00:05:51.199 our options here are yes or no, or I've never 00:05:51.199 --> 00:05:58.819 seen or heard about it before. Okay, the majority 00:05:58.819 --> 00:06:02.399 of our folks are going to know. All right, so 00:06:02.399 --> 00:06:05.620 now we're going to begin by talking about sepsis 00:06:05.620 --> 00:06:09.290 and really understanding the work that... both 00:06:09.290 --> 00:06:11.870 Fatima and Dr. Barrett have done in this area. 00:06:12.230 --> 00:06:15.389 So without further ado, I think I want to start 00:06:15.389 --> 00:06:20.069 by asking both of you, how would you define sepsis? 00:06:20.149 --> 00:06:22.810 And in which clinical setting does this really 00:06:22.810 --> 00:06:25.550 occur in? And which healthcare professionals 00:06:25.550 --> 00:06:29.110 are really best positioned to manage this condition 00:06:29.110 --> 00:06:33.550 effectively? Yeah, so sepsis is sort of defined 00:06:33.550 --> 00:06:39.360 as the body's sort of out of control over excessive 00:06:39.360 --> 00:06:43.379 inflammatory response to an infection. And it's 00:06:43.379 --> 00:06:45.259 interesting, some of the people who answered 00:06:45.259 --> 00:06:47.040 in the poll said that it was a blood infection, 00:06:47.240 --> 00:06:52.079 which is true in some ways. And so it's important 00:06:52.079 --> 00:06:54.939 to know that any infection really can cause sepsis. 00:06:54.939 --> 00:06:57.860 And it's often sort of thought of as either the 00:06:57.860 --> 00:07:00.300 bacteria or the virus is sort of eating away 00:07:00.300 --> 00:07:02.839 at the body or that there's bacteria in the blood. 00:07:02.920 --> 00:07:05.759 And while there's sometimes bacteria in the blood. 00:07:06.910 --> 00:07:09.009 It doesn't always have to be that. It can be 00:07:09.009 --> 00:07:12.490 just a soft tissue infection. And it's really 00:07:12.490 --> 00:07:15.470 the immune response, the body's immune system 00:07:15.470 --> 00:07:18.730 gets so overwhelmed and so, not overwhelmed, 00:07:18.889 --> 00:07:23.490 sorry, almost overactive that the inflammation 00:07:23.490 --> 00:07:28.089 causes organ damage. And the main way that the 00:07:28.089 --> 00:07:30.629 organ damage happens is actually through shock. 00:07:30.870 --> 00:07:34.569 So people's blood pressure is low. So that's 00:07:34.569 --> 00:07:37.310 why one of the... question where it was what 00:07:37.310 --> 00:07:39.569 are the warning signs and the sort of signs and 00:07:39.569 --> 00:07:42.910 symptoms of sepsis they're typically signs and 00:07:42.910 --> 00:07:47.269 symptoms of an infection so fever off urinary 00:07:47.269 --> 00:07:51.529 tract symptoms a wound infection um but then 00:07:51.529 --> 00:07:55.509 also not enough blood flow and oxygen delivered 00:07:55.509 --> 00:07:57.769 to the brain because the blood pressure is low 00:07:57.769 --> 00:08:01.709 so dizziness confusion um sort of not feeling 00:08:01.709 --> 00:08:04.970 like feeling foggy increased urine output because 00:08:04.970 --> 00:08:06.589 there's not enough blood flow to the kidneys 00:08:06.589 --> 00:08:11.569 um people develop sort of cold some people develop 00:08:11.569 --> 00:08:14.410 cold fingers and then some people they're actually 00:08:14.410 --> 00:08:16.410 they're red and they're hot like you're you're 00:08:16.410 --> 00:08:19.009 everything is red and sort of inflamed because 00:08:19.009 --> 00:08:23.250 you're of the inflammation um so it's it's not 00:08:23.250 --> 00:08:26.149 necessarily the infection it's the body's response 00:08:26.149 --> 00:08:30.029 to the infection um and really anyone in the 00:08:30.029 --> 00:08:32.509 health system would see someone with sepsis and 00:08:32.509 --> 00:08:34.559 that's I think a very important point that this 00:08:34.559 --> 00:08:36.620 isn't something that should be just only sort 00:08:36.620 --> 00:08:39.779 of the purview of people in acute care hospitals. 00:08:40.179 --> 00:08:42.480 We know that the majority of cases of sepsis 00:08:42.480 --> 00:08:46.139 actually originate in the community. And so any 00:08:46.139 --> 00:08:48.100 sort of first point of contact with the health 00:08:48.100 --> 00:08:52.139 system, that health provider needs to be aware 00:08:52.139 --> 00:08:53.919 of sepsis, know what it looks like, because they 00:08:53.919 --> 00:08:55.620 could be encountering it for the first time in 00:08:55.620 --> 00:08:58.580 that person's case. Yeah, so it sounds like some 00:08:58.580 --> 00:09:00.419 kind of the warning signs that you mentioned 00:09:00.419 --> 00:09:04.820 that the public and others or health care providers 00:09:04.820 --> 00:09:08.679 should be aware of are quite alarming and can 00:09:08.679 --> 00:09:12.519 sometimes happen quick as well. So it sounds 00:09:12.519 --> 00:09:17.820 like very devastating. And so is this a treatable 00:09:17.820 --> 00:09:20.720 condition? And within kind of our health care 00:09:20.720 --> 00:09:24.460 infrastructure, what types of resources do we 00:09:24.460 --> 00:09:27.679 really need to treat such a condition? So the 00:09:27.679 --> 00:09:29.419 first most important point is we need to be able 00:09:29.419 --> 00:09:32.480 to recognize it. So the clinicians looking at 00:09:32.480 --> 00:09:35.220 the patient need to be able to have the pattern 00:09:35.220 --> 00:09:37.620 recognition or the infrastructure within their 00:09:37.620 --> 00:09:41.039 system to have warnings or red flags in their 00:09:41.039 --> 00:09:44.039 EMR to say this patient is developing shock, 00:09:44.360 --> 00:09:47.240 they're developing organ dysfunction, and they 00:09:47.240 --> 00:09:50.159 have an infection. This could be sepsis. And 00:09:50.159 --> 00:09:52.600 then the most important thing, and we know there's 00:09:52.600 --> 00:09:55.549 very clear evidence about this, you need to give 00:09:55.549 --> 00:09:58.389 antibiotics as quickly as possible. And that's 00:09:58.389 --> 00:10:00.429 where I'm sure in this room it's like, oh, but 00:10:00.429 --> 00:10:05.590 that's actually an evidence -based recommendation. 00:10:06.210 --> 00:10:09.190 If you can start to treat that infection early, 00:10:09.309 --> 00:10:11.850 you can then prevent some of that later inflammation 00:10:11.850 --> 00:10:14.490 and organ damage. So it's getting control of 00:10:14.490 --> 00:10:20.120 the infection as quickly as possible. when individuals 00:10:20.120 --> 00:10:22.799 have shock associated with sepsis, they need 00:10:22.799 --> 00:10:27.000 to be treated at an acute care center because 00:10:27.000 --> 00:10:29.539 they need volume resuscitation with intravenous 00:10:29.539 --> 00:10:32.500 fluids. And so you can't really, I don't think. 00:10:32.879 --> 00:10:34.899 A family physician would be able to do that in 00:10:34.899 --> 00:10:36.700 their clinic or sort of community health centers. 00:10:36.740 --> 00:10:38.500 That's sort of beyond the scope of what could 00:10:38.500 --> 00:10:40.840 be done there. You need to be at a hospital where 00:10:40.840 --> 00:10:43.000 you can have blood work drawn, repeat blood work 00:10:43.000 --> 00:10:46.639 drawn, get IV fluids. You need to have appropriate 00:10:46.639 --> 00:10:48.759 investigations done to be able to find the source 00:10:48.759 --> 00:10:51.519 of the infection. And then also key, and I think 00:10:51.519 --> 00:10:53.879 important to this room, is appropriate cultures 00:10:53.879 --> 00:10:57.259 done so that we know what the infection is caused 00:10:57.259 --> 00:10:59.379 from so that we can then narrow the antibiotics. 00:11:00.539 --> 00:11:02.580 make sure that we're not delivering too broad 00:11:02.580 --> 00:11:05.840 spectrum antibiotics. And that ties us back to 00:11:05.840 --> 00:11:09.200 antimicrobial resistance and building resistance 00:11:09.200 --> 00:11:11.899 if we're not doing that. So definitely going 00:11:11.899 --> 00:11:14.840 kind of broad empirically, sounds like the approach 00:11:14.840 --> 00:11:17.899 being a multidisciplinary team, definitely need 00:11:17.899 --> 00:11:21.000 to be in a setting where there's enough resources 00:11:21.000 --> 00:11:24.990 to manage kind of acute changes. And with that, 00:11:25.049 --> 00:11:27.870 I mean, there comes the burden on the health 00:11:27.870 --> 00:11:31.210 care system as well. And so what have you guys 00:11:31.210 --> 00:11:34.570 seen or what are the effects or the economic 00:11:34.570 --> 00:11:37.809 burdens of this on our health care system? I 00:11:37.809 --> 00:11:39.509 think it's a really important point to highlight 00:11:39.509 --> 00:11:42.330 there. I think just even in the description that 00:11:42.330 --> 00:11:44.549 Callie provided in terms of the level of care 00:11:44.549 --> 00:11:47.570 required, we know that sepsis is going to be 00:11:47.570 --> 00:11:50.429 costly. And we even think about this from the 00:11:50.429 --> 00:11:52.850 number of Canadians that are impacted or the 00:11:52.850 --> 00:11:55.090 number of individuals worldwide impacted. So 00:11:55.090 --> 00:11:57.690 we know in Ontario alone, we're looking at upwards 00:11:57.690 --> 00:12:02.370 of a billion dollars associated. Yes, a billion 00:12:02.370 --> 00:12:06.909 dollars in Ontario associated with treating sepsis. 00:12:06.909 --> 00:12:09.190 And remember, that's sort of the hospital associated 00:12:09.190 --> 00:12:11.870 costs. I mean, all the other piece to this is 00:12:11.870 --> 00:12:14.230 that once individuals have had a sepsis case, 00:12:14.330 --> 00:12:17.230 they are at risk of coming back into our hospital 00:12:17.230 --> 00:12:20.470 systems, increased risk of diabetes, cardiovascular 00:12:20.470 --> 00:12:23.549 disease, so on and so forth. And so all of the 00:12:23.549 --> 00:12:25.970 costs associated with treating those downstream 00:12:25.970 --> 00:12:29.289 sequelae. We did a study a few years back looking 00:12:29.289 --> 00:12:32.590 at the concept of high cost users. So the individuals 00:12:32.590 --> 00:12:35.529 that make up a small portion of the population, 00:12:35.610 --> 00:12:38.509 but a disproportionate amount of health care 00:12:38.509 --> 00:12:40.789 spending. And we know that sepsis is actually 00:12:40.789 --> 00:12:44.309 a risk factor for becoming a high cost user. 00:12:44.509 --> 00:12:46.330 And so really when we're thinking about this 00:12:46.330 --> 00:12:49.090 in terms of prevention, prevention of a sepsis 00:12:49.090 --> 00:12:51.879 case could potentially yield. cost savings for 00:12:51.879 --> 00:12:54.019 the healthcare system. And this doesn't even 00:12:54.019 --> 00:12:56.840 begin to touch the pieces associated with the 00:12:56.840 --> 00:12:58.860 individual, their families, you know, not being 00:12:58.860 --> 00:13:01.659 able to return to work, the psychosocial factors 00:13:01.659 --> 00:13:05.019 associated caregiving costs and all the burdens 00:13:05.019 --> 00:13:07.019 associated with that. So we're really focused 00:13:07.019 --> 00:13:09.519 on some of those health system costs, but there 00:13:09.519 --> 00:13:13.340 are also significant costs associated with some 00:13:13.340 --> 00:13:17.500 of the downstream impacts of sepsis. Yeah. I 00:13:17.500 --> 00:13:20.460 think. One of the things that I think maybe isn't 00:13:20.460 --> 00:13:23.679 necessarily recognized unless you've experienced 00:13:23.679 --> 00:13:26.240 sepsis yourself, a loved one has or you've treated 00:13:26.240 --> 00:13:29.320 it, is the people who have really severe sepsis 00:13:29.320 --> 00:13:32.039 and have shock need to be admitted to an intensive 00:13:32.039 --> 00:13:35.200 care unit. And to treat that low blood pressure, 00:13:35.259 --> 00:13:37.639 we have to give medications to increase the blood 00:13:37.639 --> 00:13:40.559 pressure. And some of the complications associated 00:13:40.559 --> 00:13:43.039 from that medication is we actually squeeze the 00:13:43.039 --> 00:13:45.000 vessels to the point where the digits and the 00:13:45.000 --> 00:13:48.549 toes. you don't have enough circulation. So you 00:13:48.549 --> 00:13:50.929 hear about people requiring amputations when 00:13:50.929 --> 00:13:53.610 they have sepsis. And that's as a result of the 00:13:53.610 --> 00:13:57.009 blood flow being diminished blood flow to their 00:13:57.009 --> 00:13:59.350 fingers and their toes and the people that survive 00:13:59.350 --> 00:14:04.899 sepsis and have lost limbs. the the prolonged 00:14:04.899 --> 00:14:07.379 course of critical illness we know that every 00:14:07.379 --> 00:14:10.480 day in bed your muscles are just sort of atrophying 00:14:10.480 --> 00:14:12.820 and the inflammation the muscles atrophy so then 00:14:12.820 --> 00:14:15.980 people have incredible weakness um they get nerve 00:14:15.980 --> 00:14:19.179 damage so they're surviving an episode of sepsis 00:14:19.179 --> 00:14:21.539 but now they've maybe lost a limb or two they've 00:14:21.539 --> 00:14:23.620 got residual kidney dysfunction they might need 00:14:23.620 --> 00:14:26.299 dialysis for the rest of their lives they have 00:14:26.299 --> 00:14:31.159 foot drop They have intractable nerve pain. They 00:14:31.159 --> 00:14:32.940 need months and months and months and months 00:14:32.940 --> 00:14:34.820 of rehab just to have the strength to be able 00:14:34.820 --> 00:14:36.779 to sort of ambulate and toil with themselves. 00:14:37.179 --> 00:14:41.399 So for people with severe sepsis, it is a catastrophic, 00:14:41.620 --> 00:14:47.240 life -altering event. And even those who have 00:14:47.240 --> 00:14:50.279 a milder case of sepsis, you know, we spoke with 00:14:50.279 --> 00:14:52.759 someone yesterday or two days ago who had, I 00:14:52.759 --> 00:14:55.019 would say, a mild to moderate case of sepsis, 00:14:55.039 --> 00:14:59.940 needed vasopressors. continues to have sequelae 00:14:59.940 --> 00:15:02.159 is back at work but is continuing to like in 00:15:02.159 --> 00:15:03.840 and out of visits with the physician because 00:15:03.840 --> 00:15:06.139 she's having recurrent infections and things 00:15:06.139 --> 00:15:08.159 her body has just been so messed up from nine 00:15:08.159 --> 00:15:12.440 hours of sepsis so it is it's really uh it is 00:15:12.440 --> 00:15:15.440 really life -altering yeah and it sounds like 00:15:15.440 --> 00:15:18.379 from the population that affects obviously i 00:15:18.379 --> 00:15:20.519 mean there's certain risk factors for certain 00:15:20.519 --> 00:15:23.809 conditions that we know of in medicine but it 00:15:23.809 --> 00:15:26.769 can really affect you at any stage. So I know 00:15:26.769 --> 00:15:29.309 that there's cases with childbirth, there's cases, 00:15:29.629 --> 00:15:32.950 routine cases, like I work in pediatrics, so 00:15:32.950 --> 00:15:34.809 we see it all the time there as well. And you 00:15:34.809 --> 00:15:37.330 really can identify a lot of risk factors when 00:15:37.330 --> 00:15:39.049 somebody's going to have a severe presentation 00:15:39.049 --> 00:15:44.120 or milder presentation. And so I know that we 00:15:44.120 --> 00:15:46.740 talked about key kind of prevention and education 00:15:46.740 --> 00:15:48.980 around that. And I know you guys have done a 00:15:48.980 --> 00:15:52.259 lot of work around the sepsis national action 00:15:52.259 --> 00:15:55.220 plan. And so I wanted to kind of shift gears 00:15:55.220 --> 00:15:58.179 to that now, because as we know that this is 00:15:58.179 --> 00:16:03.980 a very devastating condition, we need to make 00:16:03.980 --> 00:16:09.720 awareness. Want to kind of let our audience know, 00:16:09.899 --> 00:16:12.580 and we just presented it last year as well, the 00:16:12.580 --> 00:16:15.360 symposium. I think some of our listeners were 00:16:15.360 --> 00:16:19.039 there. And so kind of what have things, what 00:16:19.039 --> 00:16:22.090 really led you to do this work? Yeah, I feel 00:16:22.090 --> 00:16:24.250 like it's worth taking a step back and going 00:16:24.250 --> 00:16:27.509 into sort of 2017 when the World Health Assembly 00:16:27.509 --> 00:16:30.809 put forward Resolution 70 .7, which really, you 00:16:30.809 --> 00:16:34.330 know, required member states to implement protocols, 00:16:34.490 --> 00:16:38.129 standards associated with, you know, survey detection, 00:16:38.429 --> 00:16:41.230 management, and so on and so forth. And I think 00:16:41.230 --> 00:16:43.210 that was really the impetus for a lot of this 00:16:43.210 --> 00:16:47.340 work, at least in 2017. Since then, we've done 00:16:47.340 --> 00:16:49.980 a lot of work sort of looking at existing policies 00:16:49.980 --> 00:16:53.440 outside of Canada to understand, you know, why 00:16:53.440 --> 00:16:55.460 they were implemented, how they were implemented, 00:16:55.659 --> 00:16:59.100 so on and so forth. In most cases, these are 00:16:59.100 --> 00:17:02.820 examples of reactive policies. So a tragedy occurs, 00:17:03.279 --> 00:17:06.759 it hits the news media, and there are subsequent 00:17:06.759 --> 00:17:09.680 efforts that are put in place. A good example 00:17:09.680 --> 00:17:12.279 of this is looking to our counterparts in the 00:17:12.279 --> 00:17:15.259 U .S., particularly in New York around Roy's 00:17:15.259 --> 00:17:18.319 regulations. These are an example of one of the 00:17:18.319 --> 00:17:21.779 first state -mandated sepsis policies that were 00:17:21.779 --> 00:17:24.400 implemented after the tragic death of a young 00:17:24.400 --> 00:17:27.119 child that could have potentially been prevented 00:17:27.119 --> 00:17:30.240 through early detection and appropriate management 00:17:30.240 --> 00:17:33.210 within the hospital setting. There are other 00:17:33.210 --> 00:17:35.390 parallel examples of this. I think we've done 00:17:35.390 --> 00:17:38.089 some work around foodborne pathogens where there 00:17:38.089 --> 00:17:41.109 have been subsequent policy efforts. And so we 00:17:41.109 --> 00:17:43.410 wanted to take a step back and think about what 00:17:43.410 --> 00:17:46.289 would a reactive, what would a coordinated plan 00:17:46.289 --> 00:17:49.589 look like for sepsis here in Canada? And so we 00:17:49.589 --> 00:17:52.750 started with a jurisdictional policy review of 00:17:52.750 --> 00:17:55.670 existing sepsis policies, guidelines, and health 00:17:55.670 --> 00:17:58.730 professional training standards in Canada. and 00:17:58.730 --> 00:18:00.970 this work is forthcoming and will hopefully be 00:18:00.970 --> 00:18:03.730 published soon, but just sort of a few tidbits 00:18:03.730 --> 00:18:07.289 from that review, we didn't identify a single 00:18:07.289 --> 00:18:10.849 sort of national policy or framework in Canada 00:18:10.849 --> 00:18:13.690 to guide what provinces and territories should 00:18:13.690 --> 00:18:16.609 potentially be implementing. And I think in the 00:18:16.609 --> 00:18:20.269 absence of that, we see a lack of policies and 00:18:20.269 --> 00:18:23.400 guidelines. most provinces and territories in 00:18:23.400 --> 00:18:26.380 Canada. And where it exists, they don't cover 00:18:26.380 --> 00:18:29.799 the breadth of populations at increased risk 00:18:29.799 --> 00:18:33.279 and limited integration of some of those international 00:18:33.279 --> 00:18:37.400 guidelines in that work. I think we talk a lot 00:18:37.400 --> 00:18:39.579 about early detection, early detection, early 00:18:39.579 --> 00:18:42.299 detection, and it's so critical. But I think 00:18:42.299 --> 00:18:44.359 in order to facilitate that, we really need to 00:18:44.359 --> 00:18:46.559 think about training for health professional 00:18:46.559 --> 00:18:49.220 training standards and whether or not this is 00:18:49.220 --> 00:18:52.539 actually included as a competency. Are physicians, 00:18:52.880 --> 00:18:55.339 nurses, or allied health professionals trained 00:18:55.339 --> 00:18:58.279 to detect the signs and symptoms and escalate 00:18:58.279 --> 00:19:00.839 care accordingly? When we look at the physician 00:19:00.839 --> 00:19:04.039 training standards, in most cases, sepsis isn't 00:19:04.039 --> 00:19:06.230 considered. And whether it is we feel that it 00:19:06.230 --> 00:19:09.390 isn't considered, you know, in a way that is 00:19:09.390 --> 00:19:12.630 appropriate for a medical emergency. And I think 00:19:12.630 --> 00:19:15.329 for nurses, for our paramedics, for our allied 00:19:15.329 --> 00:19:17.470 health professionals, I think Kelly had mentioned, 00:19:17.529 --> 00:19:19.210 you know, everyone in the health system sort 00:19:19.210 --> 00:19:21.869 of has a role to play in some of that early detection. 00:19:22.190 --> 00:19:25.640 We see a lack of consideration. And so I think 00:19:25.640 --> 00:19:29.400 that for us highlighted the opportunity to implement 00:19:29.400 --> 00:19:32.119 a sepsis national action plan that considers 00:19:32.119 --> 00:19:35.619 those important risk factors that facilitates 00:19:35.619 --> 00:19:39.019 the implementation of sepsis as a core training 00:19:39.019 --> 00:19:41.839 competency to facilitate some of those downstream 00:19:41.839 --> 00:19:45.220 pieces that we were talking about. Okay. And 00:19:45.220 --> 00:19:48.309 it sounds like other countries. As you mentioned, 00:19:48.430 --> 00:19:53.509 the U .S. particularly have a sepsis national 00:19:53.509 --> 00:19:57.369 action plan. Are the components of that, like 00:19:57.369 --> 00:19:59.829 you touched on some of them, are the components, 00:20:00.089 --> 00:20:02.710 some of those similar components that you guys 00:20:02.710 --> 00:20:06.289 integrated into your action plan? Yeah, absolutely. 00:20:06.509 --> 00:20:09.009 So other countries have implemented sepsis national 00:20:09.009 --> 00:20:10.849 action plans, and I'll give some of those examples. 00:20:11.029 --> 00:20:13.089 But I think when we're talking about that, the 00:20:13.089 --> 00:20:16.230 components really boil down to some of the prevention 00:20:16.230 --> 00:20:21.490 efforts. So thinking about vaccines and other 00:20:21.490 --> 00:20:23.950 things that can help prevent infections and then 00:20:23.950 --> 00:20:26.970 subsequent onset of sepsis, we're thinking about 00:20:26.970 --> 00:20:29.970 awareness. So I think, you know, in this audience. 00:20:30.490 --> 00:20:32.529 We saw the polls earlier, and the majority of 00:20:32.529 --> 00:20:36.250 you had said that no one in this room was impacted 00:20:36.250 --> 00:20:40.009 by sepsis. And we often hear that people learn 00:20:40.009 --> 00:20:43.849 about sepsis when a loved one has had it or a 00:20:43.849 --> 00:20:46.390 relative has had it. And we don't know, it's 00:20:46.390 --> 00:20:48.730 not common to know sort of the signs and symptoms 00:20:48.730 --> 00:20:50.829 in the same way that we know the signs and symptoms 00:20:50.829 --> 00:20:54.289 of, for example, stroke. So if someone is having 00:20:54.289 --> 00:20:56.549 a stroke, whether it's your family member, whether 00:20:56.549 --> 00:20:59.210 it's someone on the street. Even if you can't 00:20:59.210 --> 00:21:01.309 name off all of the signs and symptoms, you are 00:21:01.309 --> 00:21:04.329 able to identify that something is wrong. It's 00:21:04.329 --> 00:21:06.930 a medical emergency. You need to call 911 and 00:21:06.930 --> 00:21:09.430 get this person care. When they get to the hospital 00:21:09.430 --> 00:21:12.250 system, we have protocols and policies in place 00:21:12.250 --> 00:21:14.869 in order to escalate that care. So I think the 00:21:14.869 --> 00:21:17.190 prevention and awareness pieces are really important. 00:21:17.670 --> 00:21:20.450 And then when individuals get into the hospital 00:21:20.450 --> 00:21:23.380 system. You know, standards in the emergency 00:21:23.380 --> 00:21:26.079 department, you know, it's such a complex environment. 00:21:26.180 --> 00:21:28.460 We heard from a speaker yesterday about some 00:21:28.460 --> 00:21:30.480 of those complexities and some of the challenges, 00:21:30.559 --> 00:21:33.240 but an opportunity to protocolize some of that 00:21:33.240 --> 00:21:36.099 care so that early detection and management becomes 00:21:36.099 --> 00:21:39.259 routine. I talked a little bit about the training 00:21:39.259 --> 00:21:41.279 standards for everyone in the health system, 00:21:41.359 --> 00:21:43.579 so beyond the emergency department, what that 00:21:43.579 --> 00:21:45.700 looks like. And then I think there's opportunity 00:21:45.700 --> 00:21:48.900 for developing quality standards, quality improvement 00:21:48.900 --> 00:21:52.019 initiatives, and through all of this, integrating 00:21:52.019 --> 00:21:55.160 sort of those data pieces, our ability to understand 00:21:55.160 --> 00:21:58.779 who in Canada is actually impacted by sepsis, 00:21:58.779 --> 00:22:00.940 and whether the efforts that we're putting in 00:22:00.940 --> 00:22:03.240 place, whether those are policies, whether those 00:22:03.240 --> 00:22:06.420 are guidelines, whether that's inclusion in health 00:22:06.420 --> 00:22:09.099 professional training standards, having the intended 00:22:09.099 --> 00:22:12.990 impact. And so I think that's going to be a really, 00:22:13.029 --> 00:22:16.529 really important piece going forward. And I think 00:22:16.529 --> 00:22:19.250 the ability to report on those pieces so that 00:22:19.250 --> 00:22:22.470 we can evaluate our efforts continuously. Sounds 00:22:22.470 --> 00:22:25.289 like definitely looking at some multidisciplinary 00:22:25.289 --> 00:22:28.609 or multifaceted kind of approach is really important. 00:22:29.269 --> 00:22:32.029 And you talked about prevention, diagnostics, 00:22:32.029 --> 00:22:34.930 education. I think those are all kind of the 00:22:34.930 --> 00:22:42.009 key points. All of this, I would assume, requires 00:22:42.009 --> 00:22:46.369 a lot of money, funding. And so when we're looking 00:22:46.369 --> 00:22:51.049 at things that are burdening our health care 00:22:51.049 --> 00:22:54.190 system, such as conditions like sepsis, has there 00:22:54.190 --> 00:22:56.650 been measures by the Canadian health care system 00:22:56.650 --> 00:23:00.769 to help us implement such action plans to kind 00:23:00.769 --> 00:23:04.769 of fight or to create awareness in regards to 00:23:04.769 --> 00:23:09.099 conditions like sepsis? As our jurisdiction review 00:23:09.099 --> 00:23:12.559 identified, there isn't yet a national strategy 00:23:12.559 --> 00:23:16.579 or provincial strategies, really. And I'm actually 00:23:16.579 --> 00:23:19.559 going to, I'm not sure it would cost a ton of 00:23:19.559 --> 00:23:22.720 money to actually address this issue. A lot of 00:23:22.720 --> 00:23:24.720 the work involves just bringing together the 00:23:24.720 --> 00:23:26.579 people that are already doing work in these given 00:23:26.579 --> 00:23:29.519 areas and just ensuring that sepsis is a part 00:23:29.519 --> 00:23:33.079 of a training standard, ensuring that, you know. 00:23:33.289 --> 00:23:36.329 prioritized quality metrics for hospitals and 00:23:36.329 --> 00:23:39.009 health care centers that sepsis is one of them 00:23:39.009 --> 00:23:41.430 so this i don't think this requires a new line 00:23:41.430 --> 00:23:44.769 item in any system's health budget it just requires 00:23:44.769 --> 00:23:48.809 a bit of a reorganization maybe or re -prioritization 00:23:48.809 --> 00:23:53.829 of sepsis and i think in terms of so what has 00:23:53.829 --> 00:23:56.549 the canadian government done um you know i'll 00:23:56.549 --> 00:24:00.660 say that the aml efforts Apply to sepsis. So 00:24:00.660 --> 00:24:05.339 every person who dies of AMR is likely dying 00:24:05.339 --> 00:24:08.400 of a sepsis -related death from a resistant pathogen. 00:24:08.839 --> 00:24:13.460 So sepsis is sort of like the human face of AMR. 00:24:14.359 --> 00:24:18.519 And the Canadian government funded the Sepsis 00:24:18.519 --> 00:24:21.900 Canada, the research network. So they gave several 00:24:21.900 --> 00:24:24.640 million dollars to scientists, which Fatima and 00:24:24.640 --> 00:24:26.839 I, some of this work was supported by Sepsis 00:24:26.839 --> 00:24:30.670 Canada. And so there's been a pool of money for 00:24:30.670 --> 00:24:33.569 research. A pool of money is now spent. There's 00:24:33.569 --> 00:24:36.950 no further funding. But there hasn't been a sort 00:24:36.950 --> 00:24:40.910 of a policy research. And so that's really some 00:24:40.910 --> 00:24:43.690 of the work that we're doing. It's very hard 00:24:43.690 --> 00:24:46.710 for a single government entity to lead this work. 00:24:46.990 --> 00:24:48.869 The federal government is not going to be able 00:24:48.869 --> 00:24:50.630 to solve this problem. A provincial government 00:24:50.630 --> 00:24:52.250 is not going to be able to solve this problem. 00:24:52.390 --> 00:24:55.079 And it requires having... The key government 00:24:55.079 --> 00:24:57.140 stakeholders and the decision makers and then 00:24:57.140 --> 00:24:59.460 the clinicians and the patient partners. And 00:24:59.460 --> 00:25:01.880 so what we're hoping to do and what we're starting 00:25:01.880 --> 00:25:04.279 to bring those people together, we're laying 00:25:04.279 --> 00:25:06.799 on the ground sort of the plan of here's what 00:25:06.799 --> 00:25:09.279 we're going to do. We've mapped out what's missing. 00:25:09.839 --> 00:25:12.000 We've mapped out what exists. And then we're 00:25:12.000 --> 00:25:13.900 going to work on basically filling the holes, 00:25:14.039 --> 00:25:16.799 filling the holes in the policy gaps together, 00:25:16.960 --> 00:25:19.880 coordinated so that we're not all doing reinventing 00:25:19.880 --> 00:25:21.960 the wheel in all the different provinces. Yeah, 00:25:21.980 --> 00:25:26.299 that's fair. And I think when we, I mean, we 00:25:26.299 --> 00:25:28.859 talked about this at one of yesterday's talks 00:25:28.859 --> 00:25:31.920 in terms of the provincial healthcare differences 00:25:31.920 --> 00:25:35.579 that we have as well. So again, that poses some 00:25:35.579 --> 00:25:37.859 challenges when you're kind of coming from a 00:25:37.859 --> 00:25:41.539 national front, just with having different provincial 00:25:41.539 --> 00:25:44.619 healthcare systems. But it sounds like awareness 00:25:44.619 --> 00:25:48.180 is probably... There's a key factor in this as 00:25:48.180 --> 00:25:52.019 well, and why we're also here today to make people 00:25:52.019 --> 00:25:54.859 aware of this condition, what your guys' plan 00:25:54.859 --> 00:25:58.500 is, and that is a national plan. We talked about 00:25:58.500 --> 00:26:00.740 some of the barriers that exist, but where do 00:26:00.740 --> 00:26:03.180 you think the key kind of awareness gaps are 00:26:03.180 --> 00:26:07.079 within, let's say, the public, within policymakers 00:26:07.079 --> 00:26:10.819 or healthcare professionals? Maybe I can start 00:26:10.819 --> 00:26:13.299 with the public piece because I think that is 00:26:13.299 --> 00:26:16.559 so critical. So there was some work done by some 00:26:16.559 --> 00:26:18.839 of our colleagues, also funded by Sepsis Canada. 00:26:19.140 --> 00:26:21.180 They tried to understand, you know, how many 00:26:21.180 --> 00:26:23.960 Canadians know what sepsis is, how many Canadians 00:26:23.960 --> 00:26:26.099 know the signs and symptoms of sepsis and some 00:26:26.099 --> 00:26:28.700 of those preventative efforts. And across the 00:26:28.700 --> 00:26:32.059 board, the percentage is relatively low. I think 00:26:32.059 --> 00:26:34.240 what's important, though, is that awareness differs 00:26:34.240 --> 00:26:38.299 by region, by sex, by education and by ethnicity. 00:26:39.150 --> 00:26:41.349 I think there's a critical piece to all of this 00:26:41.349 --> 00:26:43.750 work, which is that ensuring our communication 00:26:43.750 --> 00:26:46.690 about sepsis and ensuring who has that sort of 00:26:46.690 --> 00:26:50.250 education is tailored to the populations that 00:26:50.250 --> 00:26:52.430 are at increased risk, which is often influenced 00:26:52.430 --> 00:26:55.569 by the social determinants of health, where you 00:26:55.569 --> 00:26:58.609 live, what you have access to. And I think it's 00:26:58.609 --> 00:27:02.470 really challenging because sepsis is a heterogeneous 00:27:02.470 --> 00:27:06.769 condition. Everything from any infection can 00:27:06.769 --> 00:27:09.880 lead to sepsis. Patient partners talked to us 00:27:09.880 --> 00:27:12.359 about, you know, a paper cut that led them to 00:27:12.359 --> 00:27:16.240 a sepsis incidence. You know, we've had individuals 00:27:16.240 --> 00:27:18.220 who've had pneumonia and come into hospital and 00:27:18.220 --> 00:27:20.940 there's been some downstream effects. So it is 00:27:20.940 --> 00:27:23.259 a challenging condition in that sense. But I 00:27:23.259 --> 00:27:25.599 think there's lots of opportunities to think 00:27:25.599 --> 00:27:28.180 about what prevention strategies look like. And 00:27:28.180 --> 00:27:30.839 it really starts with, you know, folks understanding 00:27:30.839 --> 00:27:33.259 what sepsis is and understanding some of those 00:27:33.259 --> 00:27:38.019 signs and symptoms. And so obviously we've talked 00:27:38.019 --> 00:27:40.599 about the components of the Sepsis National Action 00:27:40.599 --> 00:27:43.920 Plan. So what is kind of the future in this? 00:27:43.940 --> 00:27:45.920 So what future initiatives does your team have 00:27:45.920 --> 00:27:48.480 planned? I know it seems like you've definitely 00:27:48.480 --> 00:27:50.839 looked at the data. We know where some of the 00:27:50.839 --> 00:27:53.819 gaps and barriers exist. And so what does the 00:27:53.819 --> 00:27:57.779 future hold for us? Yeah. So we're starting to 00:27:57.779 --> 00:28:00.660 pull together the group. And to support this 00:28:00.660 --> 00:28:03.519 work, we're applying for CIHR funding. If we 00:28:03.519 --> 00:28:04.920 don't get the funding, we're going to still start 00:28:04.920 --> 00:28:06.740 the work and then continue to try to find funding. 00:28:07.500 --> 00:28:09.880 The first step that we're going to do is we're 00:28:09.880 --> 00:28:13.160 going to do a sort of proper comparative health 00:28:13.160 --> 00:28:15.519 system evaluation of what have other jurisdictions 00:28:15.519 --> 00:28:18.720 done and what's worked, what hasn't worked, and 00:28:18.720 --> 00:28:20.680 actually get the leaders of all the different 00:28:20.680 --> 00:28:23.400 national action plans together, host a conference. 00:28:24.440 --> 00:28:25.880 And then we're going to try to figure out what 00:28:25.880 --> 00:28:28.759 can we learn from those different examples that 00:28:28.759 --> 00:28:31.519 are applicable to Canada. The next step is we're 00:28:31.519 --> 00:28:34.059 going to bring together the key stakeholders 00:28:34.059 --> 00:28:37.539 and decision makers and health care providers 00:28:37.539 --> 00:28:40.740 and sort of people who will be implementing and 00:28:40.740 --> 00:28:44.039 map out how we are going to fill the gaps in 00:28:44.039 --> 00:28:47.200 each area. And this is going to be very different. 00:28:47.319 --> 00:28:49.539 There's going to be we need to address reporting. 00:28:50.170 --> 00:28:53.990 You know, we only, Chi Phi only reports nosocomial 00:28:53.990 --> 00:28:56.869 cases of sepsis. And I think this is one of the 00:28:56.869 --> 00:28:59.509 sort of academic decision makers, political sort 00:28:59.509 --> 00:29:02.309 of gaps is that sepsis is always viewed as an 00:29:02.309 --> 00:29:04.950 acute care condition. And we consider, you know, 00:29:04.950 --> 00:29:06.890 infection prevention and control in hospitals 00:29:06.890 --> 00:29:09.109 and hospital acquired, you know, surgical site 00:29:09.109 --> 00:29:11.390 infections and C. difficile. And those are very, 00:29:11.410 --> 00:29:13.490 very important. I'm not saying they're not important 00:29:13.490 --> 00:29:15.710 to you, but that actually that's a minority of 00:29:15.710 --> 00:29:19.069 sepsis. 80 % are coming from the community. So 00:29:19.069 --> 00:29:21.809 we're not measuring those, reporting those, tracking 00:29:21.809 --> 00:29:23.490 those. We don't know what the outcomes are for 00:29:23.490 --> 00:29:25.630 those people in sort of a comprehensive way. 00:29:25.730 --> 00:29:29.569 So reporting metrics, quality improvement metrics, 00:29:29.630 --> 00:29:32.549 making sure every hospital in the country within 00:29:32.549 --> 00:29:37.730 each province has a clear standard for how are 00:29:37.730 --> 00:29:39.549 they going to detect sepsis, how are they going 00:29:39.549 --> 00:29:44.130 to treat it, making sure all healthcare professionals 00:29:44.130 --> 00:29:47.960 know what sepsis is, making sure it's in... hospital 00:29:47.960 --> 00:29:50.579 accreditation standards so is every emergency 00:29:50.579 --> 00:29:54.940 department or recovery room medicine ward surgical 00:29:54.940 --> 00:29:57.380 ward all the different areas where sepsis could 00:29:57.380 --> 00:29:59.660 be developing and percolating in patients is 00:29:59.660 --> 00:30:01.660 that part of an accreditation standard for the 00:30:01.660 --> 00:30:05.809 hospital And then research, making sure that 00:30:05.809 --> 00:30:07.829 we have good research. And then another little 00:30:07.829 --> 00:30:09.410 point of this is going to be public awareness. 00:30:09.609 --> 00:30:12.650 So we want people to know what sepsis is. And, 00:30:12.750 --> 00:30:14.589 I mean, as a clinician, you know that so much 00:30:14.589 --> 00:30:16.210 of what we do is pattern recognition, right? 00:30:16.250 --> 00:30:18.170 And sometimes you can cognitively get down a 00:30:18.170 --> 00:30:21.230 pathway where you stop asking, what else could 00:30:21.230 --> 00:30:22.730 this be? What else could this be? What else could 00:30:22.730 --> 00:30:27.849 this be? And, you know, if patients knew what 00:30:27.849 --> 00:30:33.250 it was and they said... That's really powerful. 00:30:34.170 --> 00:30:36.849 A family member of mine called. We get these 00:30:36.849 --> 00:30:38.529 phone calls. I have this problem. What do you 00:30:38.529 --> 00:30:41.569 think? And when she started to describe it, it 00:30:41.569 --> 00:30:43.289 didn't sound that bad. And then she said, I'm 00:30:43.289 --> 00:30:45.690 worried this might be sepsis. And it immediately 00:30:45.690 --> 00:30:49.390 made me think, oh, it actually could be. You 00:30:49.390 --> 00:30:51.470 should go to the hospital. And she ended up needing 00:30:51.470 --> 00:30:54.009 to be admitted and have an abscess drained. So, 00:30:54.009 --> 00:30:58.140 you know, it's that sort of. Powering patients 00:30:58.140 --> 00:31:00.180 to be able to advocate for themselves, I think 00:31:00.180 --> 00:31:03.519 also would be very, very important in this. And 00:31:03.519 --> 00:31:06.680 so public awareness and awareness within health 00:31:06.680 --> 00:31:08.619 systems and within decision makers is going to 00:31:08.619 --> 00:31:11.500 be key. Yeah, and you bring up a lot of good 00:31:11.500 --> 00:31:13.859 points. Like we talked about, stroke symptoms 00:31:13.859 --> 00:31:16.759 and signs are very... We have advertisements 00:31:16.759 --> 00:31:21.339 and recognition. So I think your initiative sounds 00:31:21.339 --> 00:31:25.099 like creating some awareness around where the 00:31:25.099 --> 00:31:28.400 public can identify that, I think is definitely 00:31:28.400 --> 00:31:32.400 one of the key points. And it hasn't been done. 00:31:32.519 --> 00:31:37.460 I mean, for sure, I think everybody in this group 00:31:37.460 --> 00:31:40.539 probably understands that. But some of my listeners 00:31:40.539 --> 00:31:43.420 out there, they might be hearing some of this 00:31:43.420 --> 00:31:46.279 information for the first time. So thank you 00:31:46.279 --> 00:31:50.279 so much. I do want to give you guys the opportunity 00:31:50.279 --> 00:31:54.099 to kind of give one key message. I mean, there's 00:31:54.099 --> 00:31:56.119 probably a lot of key messages out of today's 00:31:56.119 --> 00:31:59.539 talk. But I think one key message that you want 00:31:59.539 --> 00:32:02.220 our audience to kind of take home from today 00:32:02.220 --> 00:32:10.259 to think about, to, you know, speak up or integrate 00:32:10.259 --> 00:32:14.509 into their decision making. Yeah, that's a tough 00:32:14.509 --> 00:32:17.829 question. I would say that my one key message 00:32:17.829 --> 00:32:20.990 would be that, you know, sepsis is a medical 00:32:20.990 --> 00:32:24.170 emergency and that, you know, a coordinated and 00:32:24.170 --> 00:32:27.450 proactive national action plan could save lives. 00:32:27.569 --> 00:32:29.650 And I think there's a role to play for everyone 00:32:29.650 --> 00:32:32.150 in this room and for the listeners. And I think 00:32:32.150 --> 00:32:33.630 we've highlighted some of those opportunities. 00:32:33.769 --> 00:32:36.369 And so we welcome that collaboration as we move 00:32:36.369 --> 00:32:42.289 forward in this work. I would say that. I think 00:32:42.289 --> 00:32:45.150 we need to stop thinking about the barriers in 00:32:45.150 --> 00:32:47.430 our health system as reasons for why we can't 00:32:47.430 --> 00:32:50.450 address this problem. We just make sure that 00:32:50.450 --> 00:32:52.130 people are working on the things that they have 00:32:52.130 --> 00:32:55.650 jurisdiction over. And so this is doable and 00:32:55.650 --> 00:32:57.930 we just need to all come to the table and work 00:32:57.930 --> 00:33:00.970 on it. Awesome. It's a great message. Well, thank 00:33:00.970 --> 00:33:04.109 you so much. I definitely, I know I learned a 00:33:04.109 --> 00:33:07.349 lot about your guys' action plan in terms of 00:33:07.349 --> 00:33:11.029 in general. I think it brought about awareness 00:33:11.029 --> 00:33:14.710 to our group here, to our listeners internationally. 00:33:15.609 --> 00:33:20.450 Maybe other centers or sites that have created 00:33:20.450 --> 00:33:23.569 such a plan would speak up and bring up their 00:33:23.569 --> 00:33:26.279 efforts. Thank you so much for doing such important 00:33:26.279 --> 00:33:29.380 work. I think it's really important, like you 00:33:29.380 --> 00:33:32.839 mentioned, to prepare to, you know, just need 00:33:32.839 --> 00:33:38.579 action. And that's and we need to prevent, you 00:33:38.579 --> 00:33:41.480 know, such devastating conditions for sure. I 00:33:41.480 --> 00:33:45.380 think the work that you guys have done is fantastic. 00:33:45.599 --> 00:33:49.680 And we look forward to hearing about more of 00:33:49.680 --> 00:33:54.599 your work. continues in this area and so I'm 00:33:54.599 --> 00:33:57.359 sure we'll have future episodes for that so thank 00:33:57.359 --> 00:33:59.799 you so much for being guests on our podcast today 00:33:59.799 --> 00:34:03.059 thank you everyone for listening and for our 00:34:03.059 --> 00:34:05.640 listeners that are tuning in virtually or they'll 00:34:05.640 --> 00:34:09.860 be able to find our podcast on Apple, Spotify 00:34:09.860 --> 00:34:15.860 or Google they I'm sure can reach out to us if 00:34:15.860 --> 00:34:18.239 there's any other comments or questions and I 00:34:18.239 --> 00:34:24.519 want to thank all of the supporters and for AMR 00:34:24.519 --> 00:34:29.199 Symposium for having us here today and being 00:34:29.199 --> 00:34:32.139 able to discuss such an important topic. Thanks 00:34:32.139 --> 00:34:32.900 so much. Thank you.