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Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies.
PLoS One. 2015; 10(5):e0125827.Plos

Abstract

BACKGROUND

Several reports suggest that implementation of the Surviving Sepsis Campaign (SSC) guidelines is associated with mortality reduction in sepsis. However, adherence to the guideline-based resuscitation and management sepsis bundles is still poor.

OBJECTIVE

To perform a systematic review of studies evaluating the impact of performance improvement programs on compliance with Surviving Sepsis Campaign (SSC) guideline-based bundles and/or mortality.

DATA SOURCES

Medline (PubMed), Scopus and Intercollegiate Studies Institute Web of Knowledge databases from 2004 (first publication of the SSC guidelines) to October 2014.

STUDY SELECTION

Studies on adult patients with sepsis, severe sepsis or septic shock that evaluated changes in compliance to individual/combined bundle targets and/or mortality following the implementation of performance improvement programs. Interventions may consist of educational programs, process changes or both.

DATA EXTRACTION

Data from the included studies were extracted independently by two authors. Unadjusted binary data were collected in order to calculate odds ratios (OR) for compliance to individual/combined bundle targets. Adjusted (if available) or unadjusted data of mortality were collected. Random-effects models were used for the data synthesis.

RESULTS

Fifty observational studies were selected. Despite high inconsistency across studies, performance improvement programs were associated with increased compliance with the complete 6-hour bundle (OR = 4.12 [95% confidence interval 2.95-5.76], I(2) = 87.72%, k = 25, N = 50,081) and the complete 24-hour bundle (OR = 2.57 [1.74-3.77], I(2) = 85.22%, k = 11, N = 45,846) and with a reduction in mortality (OR = 0.66 [0.61-0.72], I(2) = 87.93%, k = 48, N = 434,447). Funnel plots showed asymmetry.

CONCLUSIONS

Performance improvement programs are associated with increased adherence to resuscitation and management sepsis bundles and with reduced mortality in patients with sepsis, severe sepsis or septic shock.

Links

PMC Free PDF

Authors+Show Affiliations

Damiani E
Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Donati A
Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Serafini G
Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Rinaldi L
Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Adrario E
Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Pelaia P
Anesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Busani S
Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Girardis M
Department of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.

MeSH

AdultGuideline AdherenceHospital MortalityHumansIntensive Care UnitsOutcome and Process Assessment, Health CareResuscitationRisk AssessmentSepsisShock, Septic

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

25946168

Clinical Trial Links

Effect of Antibiotic Choice On ReNal Outcomes (ACORN)
Hemodynamic Resuscitation and Monitoring in Early Sepsis

Citation

Damiani, Elisa, et al. "Effect of Performance Improvement Programs On Compliance With Sepsis Bundles and Mortality: a Systematic Review and Meta-analysis of Observational Studies." PloS One, vol. 10, no. 5, 2015, pp. e0125827.
Damiani E, Donati A, Serafini G, et al. Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2015;10(5):e0125827.
Damiani, E., Donati, A., Serafini, G., Rinaldi, L., Adrario, E., Pelaia, P., Busani, S., & Girardis, M. (2015). Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. PloS One, 10(5), e0125827. https://doi.org/10.1371/journal.pone.0125827
Damiani E, et al. Effect of Performance Improvement Programs On Compliance With Sepsis Bundles and Mortality: a Systematic Review and Meta-analysis of Observational Studies. PLoS One. 2015;10(5):e0125827. PubMed PMID: 25946168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies. AU - Damiani,Elisa, AU - Donati,Abele, AU - Serafini,Giulia, AU - Rinaldi,Laura, AU - Adrario,Erica, AU - Pelaia,Paolo, AU - Busani,Stefano, AU - Girardis,Massimo, Y1 - 2015/05/06/ PY - 2014/11/11/received PY - 2015/03/26/accepted PY - 2015/5/7/entrez PY - 2015/5/7/pubmed PY - 2016/4/26/medline SP - e0125827 EP - e0125827 JF - PloS one JO - PLoS One VL - 10 IS - 5 N2 - BACKGROUND: Several reports suggest that implementation of the Surviving Sepsis Campaign (SSC) guidelines is associated with mortality reduction in sepsis. However, adherence to the guideline-based resuscitation and management sepsis bundles is still poor. OBJECTIVE: To perform a systematic review of studies evaluating the impact of performance improvement programs on compliance with Surviving Sepsis Campaign (SSC) guideline-based bundles and/or mortality. DATA SOURCES: Medline (PubMed), Scopus and Intercollegiate Studies Institute Web of Knowledge databases from 2004 (first publication of the SSC guidelines) to October 2014. STUDY SELECTION: Studies on adult patients with sepsis, severe sepsis or septic shock that evaluated changes in compliance to individual/combined bundle targets and/or mortality following the implementation of performance improvement programs. Interventions may consist of educational programs, process changes or both. DATA EXTRACTION: Data from the included studies were extracted independently by two authors. Unadjusted binary data were collected in order to calculate odds ratios (OR) for compliance to individual/combined bundle targets. Adjusted (if available) or unadjusted data of mortality were collected. Random-effects models were used for the data synthesis. RESULTS: Fifty observational studies were selected. Despite high inconsistency across studies, performance improvement programs were associated with increased compliance with the complete 6-hour bundle (OR = 4.12 [95% confidence interval 2.95-5.76], I(2) = 87.72%, k = 25, N = 50,081) and the complete 24-hour bundle (OR = 2.57 [1.74-3.77], I(2) = 85.22%, k = 11, N = 45,846) and with a reduction in mortality (OR = 0.66 [0.61-0.72], I(2) = 87.93%, k = 48, N = 434,447). Funnel plots showed asymmetry. CONCLUSIONS: Performance improvement programs are associated with increased adherence to resuscitation and management sepsis bundles and with reduced mortality in patients with sepsis, severe sepsis or septic shock. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25946168/Effect_of_performance_improvement_programs_on_compliance_with_sepsis_bundles_and_mortality:_a_systematic_review_and_meta_analysis_of_observational_studies_ DB - PRIME DP - Unbound Medicine ER -