Tags

Type your tag names separated by a space and hit enter

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.
Intensive Care Med. 2010 Feb; 36(2):222-31.IC

Abstract

OBJECTIVE

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 on process improvement and patient outcomes.

DESIGN AND SETTING

A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were "bundled" into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008.

MAIN RESULTS

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 years (P<0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). 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 years (P = 0.001). 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 years (95% CI, 2.5-8.4%).

CONCLUSIONS

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.

Links

PMC Free PDF
PMC Free Full Text
Aggregator Full Text

Authors+Show Affiliations

Levy MM
Division of Pulmonary, Sleep and Critical Care Medicine, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA. Mitchell_Levy@brown.edu
Dellinger RP
No affiliation info available
Townsend SR
No affiliation info available
Linde-Zwirble WT
No affiliation info available
Marshall JC
No affiliation info available
Bion J
No affiliation info available
Schorr C
No affiliation info available
Artigas A
No affiliation info available
Ramsay G
No affiliation info available
Beale R
No affiliation info available
Parker MM
No affiliation info available
Gerlach H
No affiliation info available
Reinhart K
No affiliation info available
Silva E
No affiliation info available
Harvey M
No affiliation info available
Regan S
No affiliation info available
Angus DC
No affiliation info available

MeSH

Confidence IntervalsGuideline AdherenceHealth PromotionHospital MortalityHumansMedical AuditOdds RatioPractice Guidelines as TopicReticulocyte CountSepsisShock, SepticTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

20069275

Citation

Levy, Mitchell M., et al. "The Surviving Sepsis Campaign: Results of an International Guideline-based Performance Improvement Program Targeting Severe Sepsis." Intensive Care Medicine, vol. 36, no. 2, 2010, pp. 222-31.
Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010;36(2):222-31.
Levy, M. M., Dellinger, R. P., Townsend, S. R., Linde-Zwirble, W. T., Marshall, J. C., Bion, J., Schorr, C., Artigas, A., Ramsay, G., Beale, R., Parker, M. M., Gerlach, H., Reinhart, K., Silva, E., Harvey, M., Regan, S., & Angus, D. C. (2010). The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Medicine, 36(2), 222-31. https://doi.org/10.1007/s00134-009-1738-3
Levy MM, et al. The Surviving Sepsis Campaign: Results of an International Guideline-based Performance Improvement Program Targeting Severe Sepsis. Intensive Care Med. 2010;36(2):222-31. PubMed PMID: 20069275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. AU - Levy,Mitchell M, AU - Dellinger,R Phillip, AU - Townsend,Sean R, AU - Linde-Zwirble,Walter T, AU - Marshall,John C, AU - Bion,Julian, AU - Schorr,Christa, AU - Artigas,Antonio, AU - Ramsay,Graham, AU - Beale,Richard, AU - Parker,Margaret M, AU - Gerlach,Herwig, AU - Reinhart,Konrad, AU - Silva,Eliezer, AU - Harvey,Maurene, AU - Regan,Susan, AU - Angus,Derek C, Y1 - 2010/01/13/ PY - 2009/05/26/received PY - 2009/11/27/accepted PY - 2010/1/14/entrez PY - 2010/1/14/pubmed PY - 2010/4/22/medline SP - 222 EP - 31 JF - Intensive care medicine JO - Intensive Care Med VL - 36 IS - 2 N2 - OBJECTIVE: 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 on process improvement and patient outcomes. DESIGN AND SETTING: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were "bundled" into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. MAIN RESULTS: 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 years (P<0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). 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 years (P = 0.001). 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 years (95% CI, 2.5-8.4%). CONCLUSIONS: 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. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/20069275/The_Surviving_Sepsis_Campaign:_results_of_an_international_guideline_based_performance_improvement_program_targeting_severe_sepsis_ L2 - https://dx.doi.org/10.1007/s00134-009-1738-3 DB - PRIME DP - Unbound Medicine ER -