It takes an intensivist

Silverman, Lora Z.; Hoesel, Laszlo M.; Desai, Aken; Posa, Patricia J.; Purtill, Mary-Anne; Brandt, Michael T.

doi:10.1016/j.amjsurg.2010.09.013

Cited by 9 publications

(10 citation statements)

References 4 publications

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“…Study characteristics are shown in S2 Table . Three studies evaluated two interventions in subsequent periods [ 53 , 57 , 60 ]; each part of these studies was included separately in order to consider the effect of each different intervention. Of the 53 resulting studies, the majority was prospective (23 before-after, 5 time-series analyses, 2 cohort, 1 case-control), 11 were retrospective (8 before-after, 2 cohort, 1 case-control), 11 were historically controlled investigations.…”

Section: Resultsmentioning

confidence: 99%

Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2015

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BackgroundSeveral 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.ObjectiveTo 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 SourcesMedline (PubMed), Scopus and Intercollegiate Studies Institute Web of Knowledge databases from 2004 (first publication of the SSC guidelines) to October 2014.Study SelectionStudies 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 ExtractionData 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.ResultsFifty 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], I2 = 87.72%, k = 25, N = 50,081) and the complete 24-hour bundle (OR = 2.57 [1.74-3.77], I2 = 85.22%, k = 11, N = 45,846) and with a reduction in mortality (OR = 0.66 [0.61-0.72], I2 = 87.93%, k = 48, N = 434,447). Funnel plots showed asymmetry.ConclusionsPerformance 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.

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Section: Resultsmentioning

confidence: 99%

Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2015

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“…The sepsis bundle was divided into the resuscitation bundle ( n = 5) and management bundle ( n = 6). In two studies [ 67 , 68 ], the general sepsis bundle contained six and 11 elements, respectively. The resuscitation bundle has a range of five to seven elements, while the management bundle contains two to four elements (Additional file 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…The compliance levels for sepsis bundles were exceptionally low compared to the central line and ventilator bundles (Additional file 3 ). Two studies reported compliance levels of 68 % [ 64 ] and 70 % [ 68 ], respectively. However, these studies were performed in small patient numbers.…”

Section: Resultsmentioning

confidence: 99%

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What are effective strategies for the implementation of care bundles on ICUs: a systematic review

2015

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BackgroundCare bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles.MethodsThe databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers.ResultsIn total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as ‘fair’ in 77 %, and the remaining as ‘good’ (13 %) and ‘poor’ (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible.ConclusionsThe three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0306-1) contains supplementary material, which is available to authorized users.

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“…There is some evidence in the human literature suggesting that intensivist‐led human ICUs achieve better outcomes . However, there have been no clinical trials comparing outcomes during the PCA period in higher level care centers to those from centers lacking advanced care capabilities.…”

Section: Pca Carementioning

confidence: 99%

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines

Fletcher

Boller

Brainard

et al. 2012

J Vet Emergen Crit Care

151

234

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Objective -To present a series of evidence-based, consensus guidelines for veterinary CPR in dogs and cats. Design -Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Questions in five domains were examined: Preparedness and Prevention, Basic Life Support, Advanced Life Support, Monitoring, and Post-Cardiac Arrest Care. Standardized worksheet templates were used for each question, and the results reviewed by the domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 4 weeks. Clinical guidelines were devised from these findings and again reviewed and commented on by the different entities within RECOVER as well as by veterinary professionals. Setting -Academia, referral practice and general practice. Results -A total of 74 worksheets were prepared to evaluate questions across the five domains. A series of 101 individual clinical guidelines were generated. In addition, a CPR algorithm, resuscitation drug-dosing scheme, and postcardiac arrest care algorithm were developed. Conclusions -Although many knowledge gaps were identified, specific clinical guidelines for small animal veterinary CPR were generated from this evidence-based process. Future work is needed to objectively evaluate the effects of these new clinical guidelines on CPR outcome, and to address the knowledge gaps identified through this process. (J Vet Emerg Crit Care 2012; 22(S1): 102-131)

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It takes an intensivist

Cited by 9 publications

References 4 publications

Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

What are effective strategies for the implementation of care bundles on ICUs: a systematic review

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines

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