Several smaller subsequent studies suggested that some of the ingredients in Rivers' protocol were not helpful, and several professional groups in critical care medicine wrote letters to the NQF to request reconsideration. They included the American College of Chest Physicians, the Greater New York Hospital Association, the Midwest Critical Care Collaborative, the Society for Academic Emergency Medicine, and the Society of Hospital Medicine.
"They said, 'You know, that fancy-dancy expensive catheter that you stick in people, maybe you can get along without that. You don't need to be doing that,'" Lilly explains. "But the NQF in June of 2013 said they were doing what they're doing, and were going to wait for more data to come out. Well this is the data they are waiting for."
Should guidelines be revised to emphasize lower-cost less-aggressive treatment, the move could have a financial impact on hospitals and payers.
Objections were expressed by the Infectious Diseases Society of America, Henry Ford Health System, Kaiser Permanente, North Shore LIJ Health System and the Institute for Healthcare Improvement.
Now, Lilly says, "when they re-examine the data, with lots of important expert opinions and these clinical trial findings, you know that some updating is going to be required," Lilly says.