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Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study.
Crit Care Med. 2015 Jan; 43(1):3-12.CC

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 three 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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Levy MM
1Alpert Medical School at Brown University, Rhode Island Hospital, Providence, Rhode Island. 2Adult Critical Care Directorate, St. George's Healthcare NHS Trust and St George's University of London, London, United Kingdom. 3The Ohio State University Center for Biostatistics, Columbus, Ohio. 4California Pacific Medical Center, San Francisco, California. 5Cooper Medical School of Rowan University, Camden, New Jersey. 6Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 7Washington University School of Medicine, St. Louis, Missouri. 8The Ohio State University College of Public Health, Columbus, Ohio. 9Hôpital Cochin, Paris, France. 10Critical Care Center, Sabadell Hospital, Autonomous University of Barcelona, Barcelona, Spain. 11Cooper Medical School of Rowan University, Camden, New Jersey.
Rhodes A
No affiliation info available
Phillips GS
No affiliation info available
Townsend SR
No affiliation info available
Schorr CA
No affiliation info available
Beale R
No affiliation info available
Osborn T
No affiliation info available
Lemeshow S
No affiliation info available
Chiche JD
No affiliation info available
Artigas A
No affiliation info available
Dellinger RP
No affiliation info available

MeSH

EuropeEvidence-Based MedicineFemaleGuideline AdherenceHospital MortalityHumansIncidenceIntensive Care UnitsLength of StayMaleOutcome and Process Assessment, Health CarePatient Care BundlesResuscitationSepsisSeverity of Illness IndexShock, SepticSouth AmericaSurvival AnalysisUnited States

Pub Type(s)

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

Language

eng

PubMed ID

25275252

Clinical Trial Links

ED Tracking Sheet Implementation
Hemodynamic Resuscitation and Monitoring in Early Sepsis
Hemostatic Agent Use and Intraoperative Blood Loss in Lumbar Spine Surgery
Effects of External Inspection on Sepsis Detection and Treatment

Citation

Levy, Mitchell M., et al. "Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-year Study." Critical Care Medicine, vol. 43, no. 1, 2015, pp. 3-12.
Levy MM, Rhodes A, Phillips GS, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43(1):3-12.
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. (2015). Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Critical Care Medicine, 43(1), 3-12. https://doi.org/10.1097/CCM.0000000000000723
Levy MM, et al. Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-year Study. Crit Care Med. 2015;43(1):3-12. PubMed PMID: 25275252.
* 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, PY - 2014/10/3/entrez PY - 2014/10/3/pubmed PY - 2015/4/22/medline SP - 3 EP - 12 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 1 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 three 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 - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25275252/Surviving_Sepsis_Campaign:_association_between_performance_metrics_and_outcomes_in_a_7_5_year_study_ DB - PRIME DP - Unbound Medicine ER -