Tags

Type your tag names separated by a space and hit enter

Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality.
Crit Care Med. 2007 Apr; 35(4):1105-12.CC

Abstract

OBJECTIVE

The purpose of this study was to examine the outcome implications of implementing a severe sepsis bundle in an emergency department as a quality indicator set with feedback to modify physician behavior related to the early management of severe sepsis and septic shock.

DESIGN

Two-year prospective observational cohort.

SETTING

Academic tertiary care facility.

PATIENTS

Patients were 330 patients presenting to the emergency department who met criteria for severe sepsis or septic shock.

INTERVENTIONS

Five quality indicators comprised the bundle for severe sepsis management in the emergency department: a) initiate central venous pressure (CVP)/central venous oxygen saturation (Scvo2) monitoring within 2 hrs; b) give broad-spectrum antibiotics within 4 hrs; c) complete early goal-directed therapy at 6 hrs; d) give corticosteroid if the patient is on vasopressor or if adrenal insufficiency is suspected; and e) monitor for lactate clearance.

MEASUREMENTS AND MAIN RESULTS

Patients had a mean age of 63.8 +/- 18.5 yrs, Acute Physiology and Chronic Health Evaluation II score 29.6 +/- 10.6, emergency department length of stay 8.5 +/- 4.4 hrs, hospital length of stay 11.3 +/- 12.9 days, and in-hospital mortality 35.2%. Bundle compliance increased from zero to 51.2% at the end of the study period. During the emergency department stay, patients with the bundle completed received more CVP/Scvo2 monitoring (100.0 vs. 64.8%, p < .01), more antibiotics (100.0 vs. 89.7%, p = .04), and more corticosteroid (29.9 vs. 16.2%, p = .01) compared with patients with the bundle not completed. In a multivariate regression analysis including the five quality indicators, completion of early goal-directed therapy was significantly associated with decreased mortality (odds ratio, 0.36; 95% confidence interval, 0.17-0.79; p = .01). In-hospital mortality was less in patients with the bundle completed compared with patients with the bundle not completed (20.8 vs. 39.5%, p < .01).

CONCLUSIONS

Implementation of a severe sepsis bundle using a quality improvement feedback to modify physician behavior in the emergency department setting was feasible and was associated with decreased in-hospital mortality.

Links

Aggregator Full Text

Authors+Show Affiliations

Nguyen HB
Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA. hbnguyen@llu.edu
Corbett SW
No affiliation info available
Steele R
No affiliation info available
Banta J
No affiliation info available
Clark RT
No affiliation info available
Hayes SR
No affiliation info available
Edwards J
No affiliation info available
Cho TW
No affiliation info available
Wittlake WA
No affiliation info available

MeSH

APACHEAgedClinical ProtocolsEmergency Service, HospitalFemaleGuideline AdherenceHospital MortalityHospitals, UniversityHumansLength of StayMaleMiddle AgedProspective StudiesQuality Indicators, Health CareSepsisSeverity of Illness IndexShock, SepticTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17334251

Clinical Trial Links

Application of Stimulated Immune Response Change to Predict Outcome of Patient With Severe Sepsis
Application of Biomarkers Change to Predict Outcome of Patient With Severe Sepsis
Electronic Application of a Severe Sepsis Screening Tool and Management Bundle

Citation

Nguyen, H Bryant, et al. "Implementation of a Bundle of Quality Indicators for the Early Management of Severe Sepsis and Septic Shock Is Associated With Decreased Mortality." Critical Care Medicine, vol. 35, no. 4, 2007, pp. 1105-12.
Nguyen HB, Corbett SW, Steele R, et al. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35(4):1105-12.
Nguyen, H. B., Corbett, S. W., Steele, R., Banta, J., Clark, R. T., Hayes, S. R., Edwards, J., Cho, T. W., & Wittlake, W. A. (2007). Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Critical Care Medicine, 35(4), 1105-12.
Nguyen HB, et al. Implementation of a Bundle of Quality Indicators for the Early Management of Severe Sepsis and Septic Shock Is Associated With Decreased Mortality. Crit Care Med. 2007;35(4):1105-12. PubMed PMID: 17334251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. AU - Nguyen,H Bryant, AU - Corbett,Stephen W, AU - Steele,Robert, AU - Banta,Jim, AU - Clark,Robin T, AU - Hayes,Sean R, AU - Edwards,Jeremy, AU - Cho,Thomas W, AU - Wittlake,William A, PY - 2007/3/6/pubmed PY - 2007/5/16/medline PY - 2007/3/6/entrez SP - 1105 EP - 12 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 4 N2 - OBJECTIVE: The purpose of this study was to examine the outcome implications of implementing a severe sepsis bundle in an emergency department as a quality indicator set with feedback to modify physician behavior related to the early management of severe sepsis and septic shock. DESIGN: Two-year prospective observational cohort. SETTING: Academic tertiary care facility. PATIENTS: Patients were 330 patients presenting to the emergency department who met criteria for severe sepsis or septic shock. INTERVENTIONS: Five quality indicators comprised the bundle for severe sepsis management in the emergency department: a) initiate central venous pressure (CVP)/central venous oxygen saturation (Scvo2) monitoring within 2 hrs; b) give broad-spectrum antibiotics within 4 hrs; c) complete early goal-directed therapy at 6 hrs; d) give corticosteroid if the patient is on vasopressor or if adrenal insufficiency is suspected; and e) monitor for lactate clearance. MEASUREMENTS AND MAIN RESULTS: Patients had a mean age of 63.8 +/- 18.5 yrs, Acute Physiology and Chronic Health Evaluation II score 29.6 +/- 10.6, emergency department length of stay 8.5 +/- 4.4 hrs, hospital length of stay 11.3 +/- 12.9 days, and in-hospital mortality 35.2%. Bundle compliance increased from zero to 51.2% at the end of the study period. During the emergency department stay, patients with the bundle completed received more CVP/Scvo2 monitoring (100.0 vs. 64.8%, p < .01), more antibiotics (100.0 vs. 89.7%, p = .04), and more corticosteroid (29.9 vs. 16.2%, p = .01) compared with patients with the bundle not completed. In a multivariate regression analysis including the five quality indicators, completion of early goal-directed therapy was significantly associated with decreased mortality (odds ratio, 0.36; 95% confidence interval, 0.17-0.79; p = .01). In-hospital mortality was less in patients with the bundle completed compared with patients with the bundle not completed (20.8 vs. 39.5%, p < .01). CONCLUSIONS: Implementation of a severe sepsis bundle using a quality improvement feedback to modify physician behavior in the emergency department setting was feasible and was associated with decreased in-hospital mortality. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17334251/Implementation_of_a_bundle_of_quality_indicators_for_the_early_management_of_severe_sepsis_and_septic_shock_is_associated_with_decreased_mortality_ L2 - https://dx.doi.org/10.1097/01.CCM.0000259463.33848.3D DB - PRIME DP - Unbound Medicine ER -