Resuscitation Bundle Compliance in Severe Sepsis and Septic Shock

Coba, Victor; Whitmill, Melissa L.; Mooney, Robert A.; Horst, H. Mathilda; Brandt, Michael T.; DiGiovine, Bruno; Mlynarek, Mark; McLellan, Beth N.; Boleski, Gail; Yang, James; Conway, William; Jordan, John R.

doi:10.1177/0885066610392499

Cited by 55 publications

(19 citation statements)

References 20 publications

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“…One study by Kumar et al demonstrated improved compliance to the sepsis six (oxygen, blood cultures, antibiotics, lactate measurement, intravenous fluids, and urine output monitoring) from 29% pre-intervention to 63% post-intervention, but without demonstrable improvement in outcomes [18]. However, most studies indicate improved outcomes even with modest adherence to bundled care [9] [19–22]. Our program was similar to others with regards to provision of the 3-hour bundle, with our institution adding components of education, electronic recognition, designated response teams, and RRT.…”

Section: Discussionmentioning

confidence: 99%

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

Guirgis

Merlo

Esma

et al. 2017

Journal of Critical Care

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Purpose Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Materials and methods Retrospective review of patients ≥18 years treated for sepsis. Results There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p = 0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p = 0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39–0.99, p = 0.046), mean intensive care unit LOS (2.12 days before, 95%CI 1.97, 2.34; 1.95 days after, 95%CI 1.75, 2.06; p < 0.001), mean overall hospital LOS (11.7 days before, 95% CI 10.9, 12.7 days; 9.9 days after, 95% CI 9.3, 10.6 days, p < 0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p = 0.007), and total charges with a savings of $7159 per sepsis admission (p = 0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p = 0.18). Conclusion A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis.

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Section: Discussionmentioning

confidence: 99%

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

Guirgis

Merlo

Esma

et al. 2017

Journal of Critical Care

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“…25 On the contrary, in 498 patients with severe sepsis or septic shock, compliance with a sepsis resuscitation bundle at 18 hours demonstrated a significant mortality benefit with mortality decreased from 47.3% to 37.1%. 26 …”

Section: Discussionmentioning

confidence: 99%

Improving Outcomes in Patients With Sepsis

et al. 2014

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Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = −1.98 to −0.16), 2.15 fewer hospital days (95% CI = −3.45 to −0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function.

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“…Schramm et al implemented weekly feedback to care teams regarding their compliance in addition to starting a sepsis response team. Similarly, Coba et al showed that monitoring the implementation of the resuscitation bundle elements by a continuous quality initiative, resulted in improvements in compliance and mortality (Coba et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Peer Review #1 of "Multifaceted interventions to decrease mortality in patients with severe sepsis/septic shock—a quality improvement project (v0.1)"

Larkin¹

2015

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Despite knowledge that EGDT improves outcomes in septic patients, staff education on EGDT and compliance with the CPOE order set has been variable. Based on results of a resident survey to identify barriers to decrease severe sepsis/septic shock mortality in the medical intensive care unit (MICU), multifaceted interventions such as educational interventions to improve awareness to the importance of early goal-directed therapy (EGDT), and the use of the Computerized Physician Order Entry (CPOE) order set, were implemented in July 2013. CPOE order set was established to improve compliance with the EGDT resuscitation bundle elements. Orders were reviewed and compared for patients admitted to the MICU with severe sepsis/septic shock in July and August 2013 (controls) and 2014 (following the intervention). Similarly, educational slide sets were used as interventions for residents before the start of their ICU rotations in July and August 2013. While CPOE order set compliance did not significantly improve (78% vs 76%, p=0.74), overall EGDT adherence improved from 43% to 68% (p=0.0295). Although there was a trend toward improved mortality, this did not reach statistical significance. This study shows that education interventions can be used to increase awareness of severe sepsis/septic shock and improve overall EGDT adherence.

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Resuscitation Bundle Compliance in Severe Sepsis and Septic Shock

Cited by 55 publications

References 20 publications

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives

Improving Outcomes in Patients With Sepsis

Peer Review #1 of "Multifaceted interventions to decrease mortality in patients with severe sepsis/septic shock—a quality improvement project (v0.1)"

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