Abstract
The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations. A multifaceted intervention to facilitate compliance with selected guideline recommendations in the intensive care unit, emergency department, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the United States, Europe, and South America. Elements of the guidelines were "bundled" into two sets of targets to be completed within 6 hrs and within 24 hrs. An analysis was conducted on data submitted from January 2005 through March 2008. A total of 15,022 subjects. Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 yrs (p < .0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 yrs (p = .008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37% to 30.8% over 2 yrs (p = .001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 yrs (95% confidence interval, 2.5-8.4). The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.
Highlights
Model fit well
Excluding hospitals that contributed fewer than 20 subjects, the final sample After adjustment for baseline characteristics, administraconsisted of 15,022 patients at 165 hospitals
Data from 0.79–0.93, P \ 0.0001), obtaining blood cultures before up to eight quarters were analyzed from each site. their initiation, Table 2 Cohort characteristics
Summary
The model assessing plateau pressure control in mechanically Change in achievement of bundle targets over time ventilated subjects included the baseline subject characteristics and the base set of bundle elements. The Compliance rates for achieving all bundle targets over model assessing the administration of drotrecogin alfa, time—both the overall bundles and the individual elelow-dose steroids, CVP [8, and ScvO2 [70 in subjects in ments within both bundles—increased over time, shock despite fluids included the baseline subject both basal achievement rates and the magnitude characteristics and the base set of bundle elements.
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