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Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain.
JAMA. 2008 May 21; 299(19):2294-303.JAMA

Abstract

CONTEXT

Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education.

OBJECTIVE

To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis.

DESIGN, SETTING, AND PATIENTS

Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs.

INTERVENTION

The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours).

MAIN OUTCOME MEASURES

Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay.

RESULTS

Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P < .001) and in the sepsis management bundle (10.9% [95% CI, 9%-13%] vs 15.7% [95% CI, 14%-18%]; P = .001). Hospital length of stay and ICU length of stay did not change after the intervention. During long-term follow-up, compliance with the sepsis resuscitation bundle returned to baseline but compliance with the sepsis management bundle and mortality remained stable with respect to the postintervention period.

CONCLUSIONS

A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year.

Authors+Show Affiliations

Centro de Críticos, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Instituto Universitario Parc Tauli, Universidad Autónoma de Barcelona, Barcelona, Spain. rferrer@tauli.catNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18492971

Citation

Ferrer, Ricard, et al. "Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain." JAMA, vol. 299, no. 19, 2008, pp. 2294-303.
Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299(19):2294-303.
Ferrer, R., Artigas, A., Levy, M. M., Blanco, J., González-Díaz, G., Garnacho-Montero, J., Ibáñez, J., Palencia, E., Quintana, M., & de la Torre-Prados, M. V. (2008). Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA, 299(19), 2294-303. https://doi.org/10.1001/jama.299.19.2294
Ferrer R, et al. Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain. JAMA. 2008 May 21;299(19):2294-303. PubMed PMID: 18492971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. AU - Ferrer,Ricard, AU - Artigas,Antonio, AU - Levy,Mitchell M, AU - Blanco,Jesús, AU - González-Díaz,Gumersindo, AU - Garnacho-Montero,José, AU - Ibáñez,Jordi, AU - Palencia,Eduardo, AU - Quintana,Manuel, AU - de la Torre-Prados,María Victoria, AU - ,, PY - 2008/5/22/pubmed PY - 2008/5/29/medline PY - 2008/5/22/entrez SP - 2294 EP - 303 JF - JAMA JO - JAMA VL - 299 IS - 19 N2 - CONTEXT: Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE: To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis. DESIGN, SETTING, AND PATIENTS: Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs. INTERVENTION: The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours). MAIN OUTCOME MEASURES: Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay. RESULTS: Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P < .001) and in the sepsis management bundle (10.9% [95% CI, 9%-13%] vs 15.7% [95% CI, 14%-18%]; P = .001). Hospital length of stay and ICU length of stay did not change after the intervention. During long-term follow-up, compliance with the sepsis resuscitation bundle returned to baseline but compliance with the sepsis management bundle and mortality remained stable with respect to the postintervention period. CONCLUSIONS: A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/18492971/Improvement_in_process_of_care_and_outcome_after_a_multicenter_severe_sepsis_educational_program_in_Spain_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.299.19.2294 DB - PRIME DP - Unbound Medicine ER -