Impact of multimodal strategy on sepsis bundle compliance and in- hospital mortality in patients with hematologic malignancies

Abstract

Introduction: Sepsis is one of the leading causes of mortality in patients with hematologic malignancies. Our aim is evaluate the impact of multimodal strategy on sepsis bundle compliance and in-hospital mortality in patients with hematologic malignancies. Methods:We conducted a quasi-experimental study that included patients with hematologic malignancies and sepsis or septic shock, between January 1, 2017 and August 31, 2020. The study comprised two phases: phase 1, survey of sepsis and sepsis shock cases and reformulation of the sepsis team and sepsis bundle; phase 2, staff training, monthly meetings of the sepsis team and feedback for care teams. The followup of patients was for 30 days, during hospitalization, or until death. Data were analyzed with descriptive and inferential statistics, with a 95% significance interval. And the tests considered a 5% significance level. Results: A total of 329 (42.5%) patients were included. The proportion of sepsis was 241 (73.3%) and septic shock 88 (26.7%). We observed an increase in the 3h-bundle compliance in the phase 2 (86.8%), compared to the phase 1 (71.3%), with p=0.001. The in-hospital mortality was lower in the 2nd phase (38.2%), compared to the first phase (51.5%), with p=0.024. These results were mainly observed in cases of sepsis identified in the wards. Conclusions:The multimodal strategy had an impact on increasing the rate of compliance to the sepsis bundle. In-hospital mortality significantly reduced in the intervention phase of the study.