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Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia.
Int J Qual Health Care. 2012 Oct; 24(5):452-62.IJ

Abstract

OBJECTIVE

To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.

DESIGN

Prospective cohort study.

SETTING

Eight urban hospitals, five countries in Asia.

PARTICIPANTS

Adult patients with severe sepsis or septic shock.

INTERVENTIONS

Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.

MAIN OUTCOME MEASURES

Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.

METHODS

In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care.

RESULTS

Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables.

CONCLUSIONS

Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model.

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Authors+Show Affiliations

Na S
Department of Emergency Medicine and Department of Medicine, Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA 92354, USA.
Kuan WS
No affiliation info available
Mahadevan M
No affiliation info available
Li CH
No affiliation info available
Shrikhande P
No affiliation info available
Ray S
No affiliation info available
Batech M
No affiliation info available
Nguyen HB
No affiliation info available
ATLAS Investigators
No affiliation info available

MeSH

APACHEAgedAsiaFemaleGuideline AdherenceHospital MortalityHospitals, UrbanHumansLength of StayMaleMiddle AgedPatient Care TeamPractice Guidelines as TopicProspective StudiesResuscitationSepsisShock, SepticTime Factors

Pub Type(s)

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

Language

eng

PubMed ID

22899698

Citation

Na, Sungwon, et al. "Implementation of Early Goal-directed Therapy and the Surviving Sepsis Campaign Resuscitation Bundle in Asia." International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, vol. 24, no. 5, 2012, pp. 452-62.
Na S, Kuan WS, Mahadevan M, et al. Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. Int J Qual Health Care. 2012;24(5):452-62.
Na, S., Kuan, W. S., Mahadevan, M., Li, C. H., Shrikhande, P., Ray, S., Batech, M., & Nguyen, H. B. (2012). Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care, 24(5), 452-62. https://doi.org/10.1093/intqhc/mzs045
Na S, et al. Implementation of Early Goal-directed Therapy and the Surviving Sepsis Campaign Resuscitation Bundle in Asia. Int J Qual Health Care. 2012;24(5):452-62. PubMed PMID: 22899698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. AU - Na,Sungwon, AU - Kuan,Win Sen, AU - Mahadevan,Malcolm, AU - Li,Chih-Huang, AU - Shrikhande,Pinak, AU - Ray,Sumit, AU - Batech,Michael, AU - Nguyen,H Bryant, AU - ,, Y1 - 2012/08/16/ PY - 2012/8/18/entrez PY - 2012/8/18/pubmed PY - 2013/2/21/medline SP - 452 EP - 62 JF - International journal for quality in health care : journal of the International Society for Quality in Health Care JO - Int J Qual Health Care VL - 24 IS - 5 N2 - OBJECTIVE: To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care. DESIGN: Prospective cohort study. SETTING: Eight urban hospitals, five countries in Asia. PARTICIPANTS: Adult patients with severe sepsis or septic shock. INTERVENTIONS: Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles. MAIN OUTCOME MEASURES: Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model. METHODS: In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care. RESULTS: Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables. CONCLUSIONS: Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model. SN - 1464-3677 UR - https://www.unboundmedicine.com/medline/citation/22899698/Implementation_of_early_goal_directed_therapy_and_the_surviving_sepsis_campaign_resuscitation_bundle_in_Asia_ L2 - https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzs045 DB - PRIME DP - Unbound Medicine ER -