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Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study.
Intensive Care Med. 2014 Nov; 40(11):1623-33.IC

Abstract

PURPOSE

To determine the association between compliance with the Surviving Sepsis Campaign (SSC) performance bundles and mortality.

DESIGN

Compliance with the SSC performance bundles, which are based on the 2004 SSC guidelines, was measured in 29,470 subjects entered into the SSC database from January 1, 2005 through June 30, 2012. Compliance was defined as evidence that all bundle elements were achieved.

SETTING

Two hundred eighteen community, academic, and tertiary care hospitals in the United States, South America, and Europe.

PATIENTS

Patients from the emergency department, medical and surgical wards, and ICU who met diagnosis criteria for severe sepsis and septic shock.

METHODS

A multifaceted, collaborative change intervention aimed at facilitating adoption of the SSC resuscitation and management bundles was introduced. Compliance with the SSC bundles and associated mortality rate was the primary outcome variable.

RESULTS

Overall lower mortality was observed in high (29.0%) versus low (38.6%) resuscitation bundle compliance sites (p < 0.001) and between high (33.4%) and low (32.3%) management bundle compliance sites (p = 0.039). Hospital mortality rates dropped 0.7% per site for every 3 months (quarter) of participation (p < 0.001). Hospital and intensive care unit length of stay decreased 4% (95% CI 1-7%; p = 0.012) for every 10% increase in site compliance with the resuscitation bundle.

CONCLUSIONS

This analysis demonstrates that increased compliance with sepsis performance bundles was associated with a 25% relative risk reduction in mortality rate. Every 10% increase in compliance and additional quarter of participation in the SSC initiative was associated with a significant decrease in the odds ratio for hospital mortality. These results demonstrate that performance metrics can drive change in clinical behavior, improve quality of care, and may decrease mortality in patients with severe sepsis and septic shock.

Authors+Show Affiliations

Alpert Medical School at Brown University, Rhode Island Hospital, Providence, RI, USA, Mitchell_Levy@brown.edu.No 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
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25270221

Citation

Levy, Mitchell M., et al. "Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-year Study." Intensive Care Medicine, vol. 40, no. 11, 2014, pp. 1623-33.
Levy MM, Rhodes A, Phillips GS, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Med. 2014;40(11):1623-33.
Levy, M. M., Rhodes, A., Phillips, G. S., Townsend, S. R., Schorr, C. A., Beale, R., Osborn, T., Lemeshow, S., Chiche, J. D., Artigas, A., & Dellinger, R. P. (2014). Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Intensive Care Medicine, 40(11), 1623-33. https://doi.org/10.1007/s00134-014-3496-0
Levy MM, et al. Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-year Study. Intensive Care Med. 2014;40(11):1623-33. PubMed PMID: 25270221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. AU - Levy,Mitchell M, AU - Rhodes,Andrew, AU - Phillips,Gary S, AU - Townsend,Sean R, AU - Schorr,Christa A, AU - Beale,Richard, AU - Osborn,Tiffany, AU - Lemeshow,Stanley, AU - Chiche,Jean-Daniel, AU - Artigas,Antonio, AU - Dellinger,R Phillip, Y1 - 2014/10/01/ PY - 2014/08/31/received PY - 2014/09/12/accepted PY - 2014/10/2/entrez PY - 2014/10/2/pubmed PY - 2015/7/2/medline SP - 1623 EP - 33 JF - Intensive care medicine JO - Intensive Care Med VL - 40 IS - 11 N2 - PURPOSE: To determine the association between compliance with the Surviving Sepsis Campaign (SSC) performance bundles and mortality. DESIGN: Compliance with the SSC performance bundles, which are based on the 2004 SSC guidelines, was measured in 29,470 subjects entered into the SSC database from January 1, 2005 through June 30, 2012. Compliance was defined as evidence that all bundle elements were achieved. SETTING: Two hundred eighteen community, academic, and tertiary care hospitals in the United States, South America, and Europe. PATIENTS: Patients from the emergency department, medical and surgical wards, and ICU who met diagnosis criteria for severe sepsis and septic shock. METHODS: A multifaceted, collaborative change intervention aimed at facilitating adoption of the SSC resuscitation and management bundles was introduced. Compliance with the SSC bundles and associated mortality rate was the primary outcome variable. RESULTS: Overall lower mortality was observed in high (29.0%) versus low (38.6%) resuscitation bundle compliance sites (p < 0.001) and between high (33.4%) and low (32.3%) management bundle compliance sites (p = 0.039). Hospital mortality rates dropped 0.7% per site for every 3 months (quarter) of participation (p < 0.001). Hospital and intensive care unit length of stay decreased 4% (95% CI 1-7%; p = 0.012) for every 10% increase in site compliance with the resuscitation bundle. CONCLUSIONS: This analysis demonstrates that increased compliance with sepsis performance bundles was associated with a 25% relative risk reduction in mortality rate. Every 10% increase in compliance and additional quarter of participation in the SSC initiative was associated with a significant decrease in the odds ratio for hospital mortality. These results demonstrate that performance metrics can drive change in clinical behavior, improve quality of care, and may decrease mortality in patients with severe sepsis and septic shock. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/25270221/Surviving_Sepsis_Campaign:_association_between_performance_metrics_and_outcomes_in_a_7_5_year_study_ L2 - https://dx.doi.org/10.1007/s00134-014-3496-0 DB - PRIME DP - Unbound Medicine ER -