Assessing the Effect of the Surviving Sepsis Campaign Treatment Guidelines on Clinical Outcomes in a Community Hospital

Patel, Gita; Roderman, Nicki; Gehring, Hollie; Saad, John; Bartek, William

doi:10.1345/aph.1p251

Cited by 24 publications

(23 citation statements)

References 14 publications

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“…Other observational and quasiexperimental studies reported similar results (40,55,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92). When EGDT was incorporated into a clinical pathway for the treatment of severe sepsis and septic shock, hospital mortality could be decreased (93).…”

Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 61%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

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Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 61%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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“…[7] reported that the mortality in the compliant group decreased from 49% to 23% ( p = 0.01), compared with the non-compliant group. Mortality was 61.1% in the non-bundle group versus 20% with the bundle ( p < 0.001) [15]. Delivery of the interventions had an association with reduced mortality: for the sepsis six, 20.0% compared with 44.1% ( p < 0.001); for the resuscitation bundle, 5.9% compared with 51% ( p < 0.001) [14].…”

Section: Discussionmentioning

confidence: 99%

Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country

Guo¹,

Li²,

Li³

et al. 2014

aoms

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IntroductionValidation of compliance with severe sepsis bundles is still needed. The purpose of this study was to determine compliance and its outcomes in severe community-acquired pneumonia (CAP) patients in a limited resources country.Material and methodsA prospective cohort study of 212 severe CAP patients was carried out. The implementation programme was organized into two continuous phases. The primary outcomes were compliance and hospital mortality.ResultsCompliance with administration of antibiotics and vasopressors as well as plateau pressure on average < 30 cm H2O was high in both groups. In the bundles group, patients received more serum lactate monitoring (62.3% vs. 11.3%), more blood cultures (47.1% vs. 24.5%), more fluid resuscitation (63.2% vs. 26.4%) and volumes infused (1319.8 ±1107.4 ml vs. 461.9 ±799.3 ml), more inotropic dobutamine and/or packed red blood cells (21.7% vs. 10.0%), more low-dose steroids (56.5% vs. 15.0%), and more glucose control (51.9% vs. 6.6%) compared with such patients in the control group. The rates of total compliance with 6-hour, 24-hour, and 6/24-hour bundles in the prospective period were 47.1%, 51.9%, and 42.5%, respectively. Hospital mortality was reduced from 44.3% to 29.2% (p = 0.023) in the bundles group, and the compliant subgroup had a more than twofold decrease in mortality (17.8% vs. 37.7%, p = 0.003). Serum lactate measured, blood cultures, and fluid resuscitation showed independent relationships with decreased mortality.ConclusionsTotal compliance was relatively low, but the implementation of severe sepsis bundles could clearly reduce mortality from severe CAP.

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“…The recent development and implementation of international guidelines for management of severe sepsis and septic shock or multidisciplinary care in the intensive care unit (ICU) might decrease the incidence of mortality that was observed in complicated PUDs until 2004 [20,21]. The relatively low number of gastric procedures performed in western countries, compared with Japan, might not enable western clinicians to undertake a community-based study such as ours [22].…”

Section: Discussionmentioning

confidence: 99%

Reappraising the Surgical Approach on the Perforated Gastroduodenal Ulcer: Should Gastric Resection Be Abandoned?

et al. 2011

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BackgroundAdvancements in medical care for peptic ulcer disease (PUD) have reduced the need for invasive surgical procedures such as gastric resection (GR). Community-based PUD studies from a large sampling of PUD patients designed to analyze hospital resource use and outcomes after different surgical procedures have been rare. We aimed to exhaustively reappraise the risk factors and patient demographics that affect PUD patient recoveries after GR compared to those after simple closure (SC).MethodsWe used a Japanese administrative database for 6 consecutive months each year between 2006 and 2010. The database included a total of 68,432 PUD patients; we analyzed 6,334 perforation cases and 3,148 cases of patients who underwent GR or SC. Study variables were demographics, comorbidities, characteristics of PUD, and operative day. Study outcomes that were analyzed included mortality, postoperative complications, ventilation administration, postoperative blood transfusions, length of stay, total charges, operating room (OR) time, and the postoperative fasting period (defined as the day of surgery to the day oral food intake was resumed.) To reduce selection bias in study procedures and to control the variation in hospital practice, a propensity score (PS) matching cohort analysis and a mixed linear regression model were used to assess the effects of GR on the outcomes.ResultsIn 699 hospitals, 322 GRs and 2,826 SCs were observed. Younger age, duodenal ulcers, preexisting anemia and an operative day no more than 24hours were significant associated with the choice of SCs. No significant differences were observed in study outcomes after either GR or SC; more postoperative blood transfusions and longer OR times but shorter postoperative fasting periods were observed after GR. Longer OR times, ventilation and postoperative blood transfusion were significantly associated with mortality. Not GR but longer OR times use of ventilation and complications were the most significant indicators of increased resource use.ConclusionsThere were no major significant differences in GR when compared to SC with regards to patient recoveries. Surgeons should obtain the skills and establish strategies to optimize either type of surgical procedure including minimizing OR time and establishing the best perioperative critical care.KeywordsPeptic ulcer perforation; Simple closure; Gastric resection; Outcome; Resource use

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Assessing the Effect of the Surviving Sepsis Campaign Treatment Guidelines on Clinical Outcomes in a Community Hospital

Abstract: Implementation of a 2-part sepsis bundle based on the Surviving Sepsis Campaign Guidelines can yield a positive impact on clinical outcome and mortality in a nonacademic, community hospital setting.

Cited by 24 publications

References 14 publications

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country

Reappraising the Surgical Approach on the Perforated Gastroduodenal Ulcer: Should Gastric Resection Be Abandoned?

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