Survival Benefit and Cost Savings From Compliance With a Simplified 3-Hour Sepsis Bundle in a Series of Prospective, Multisite, Observational Cohorts

Leisman, Daniel E.; Doerfler, Martin E.; Ward, M.F.; Masick, Kevin D.; Wie, Benjamin; Gribben, Jeanie L.; Hamilton, Eric G.; Klein, Zachary; Bianculli, Andrea R.; Akerman, Meredith; D’Angelo, John; D’Amore, Jason

doi:10.1097/ccm.0000000000002184

Cited by 111 publications

(101 citation statements)

References 26 publications

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“…Rhodes revealed a 40% reduction in the odds of sepsis patients dying in the hospital when the ICU was in compliance with the 3-h bundle [21]. Leisman et al revealed that 3-h SSC bundle compliance was associated with improved survival and cost savings [22]. However, our study did not find that increased SSC bundle compliance decreased ICU mortality.…”

Section: Discussioncontrasting

confidence: 74%

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Ma²,

et al. 2020

Crit Care

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Introduction: Patient safety and critical care quality remain a challenging issue in the ICU. However, the effects of the national quality improvement (QI) program remain unknown in China. Methods: A national ICU QI program was implemented in a controlled cohort of 586 hospitals from 2016 to 2018. The effects of the QI program on critical care quality were comprehensively investigated. Main results: A total of 81,461,554 patients were enrolled in 586 hospitals, and 1,587,724 patients were admitted to the ICU over 3 years. In 2018, there was a significantly higher number of ICU beds (2016 vs. 2018: 10668 vs. 13,661, P = 0.0132) but a lower doctor-to-bed ratio (2016 vs. 2018: 0.64 (0.50, 0.83) vs. 0.60 (0.45, 0.75), P = 0.0016) and nurse-to-bed ratio (2016 vs. 2018: 2.00 (1.64, 2.50) vs. 2.00 (1.50, 2.40), P = 0.031) than in 2016. Continuous and significant improvements in the ventilator-associated pneumonia (VAP) incidence rate, microbiology detection rate before antibiotic use and deep vein thrombosis (DVT) prophylaxis rate were associated with the implementation of the QI program (VAP incidence rate (per 1000 ventilator-days), 2016 vs. 0.0093). Moreover, the 6-h SSC bundle compliance rates in 2018 were significantly higher than those in 2016 (6-h SSC bundle compliance rate, 2016 vs. 2018: 64.93 (33.55, 93.06) vs. 76.19 (46.88, 96.67)). A significant change trend was not found in the ICU mortality rate from 2016 to 2018 (ICU mortality rate (%), 2016 vs. 2017 vs. 2018: 8.49 (4.42, 14.82) vs. 8.95 (4.89, 15.70) vs. 9.05 (5.12, 15.80), P = 0.1075). Conclusions: The relationship between medical human resources and ICU overexpansion was mismatched during the past 3 years. The implementation of a national QI program improved ICU performance but did not reduce ICU mortality.

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Section: Discussioncontrasting

confidence: 74%

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Ma²,

et al. 2020

Crit Care

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“…While evidence supporting the efficacy of specific 3-hour bundle elements remains unsettled, 19 a wealth of literature demonstrates a correlation between bundle uptake and decreased sepsis mortality, especially for early antibiotic administration. 13,[20][21][22][23][24][25][26] Some analysis suggests that differing initial resuscitation practices explain different mortality rates in the early goal-directed therapy trials. 27 The comparatively poor performance for non-ICU HPS indicates further QI efforts are better focused on inpatient wards, rather than on EDs or ICUs where resuscitation is already delivered with substantially greater fidelity.…”

Section: Discussionmentioning

confidence: 99%

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

Leisman

Angel

Schneider

et al. 2019

Journal of Hospital Medicine

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epsis is both the most expensive condition treated and the most common cause of death in hospitals in the United States. [1][2][3] Most sepsis patients (as many as 80% to 90%) meet sepsis criteria on hospital arrival, but mortality and costs are higher when meeting criteria after admission. [3][4][5][6] Mechanisms of this increased mortality for these distinct populations are not well explored. Patients who present septic in the emergency department (ED) and patients who present as inpatients likely present very different challenges for recognition, treatment, and monitoring. 7 Yet, how these groups differ by demographic and clinical characteristics, the etiology and severity of infection, and patterns of resuscitation care are not well described. Literature on sepsis epidemiology on hospital wards is particularly limited. 8 This knowledge gap is important. If hospital-presenting sepsis (HPS) contributes disproportionately to disease burd-CHFens, it reflects a high-yield population deserving the focus of quality improvement (QI) initiatives. If specific causes of disparities were identified-eg, poor initial resuscitation-they could be specifically targeted for correction. Given that current treatment guidelines are uniform for the two populations, 9,10 characterizing phenotypic differences could also have implications for both diagnostic and therapeutic recommendations, particularly if the groups display substantially differing clinical

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“…Current recommendations from the Surviving Sepsis Campaign suggest resuscitating patients with sepsis-induced hypoperfusion with at least 30 ml/kg of IV crystalloid within the first 3 h [3]. The Surviving Sepsis bundles have been associated with improved survival in numerous largescale studies [4,6,47], although the specific importance of each individual component of the bundle is unclear. It should be noted that while more rapid completion of the 3 h bundle and rapid administration of antibiotics was associated with improved outcome in a study of nearly 50,000 patients, a longer time to completion of initial fluid bolus was not associated with a change in mortality [6].…”

Section: Fluids and Vasopressorsmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Survival Benefit and Cost Savings From Compliance With a Simplified 3-Hour Sepsis Bundle in a Series of Prospective, Multisite, Observational Cohorts

Abstract: In three independent cohorts, 3-hour bundle compliance was associated with improved survival and cost savings.

Cited by 111 publications

References 26 publications

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

Surviving sepsis campaign: research priorities for sepsis and septic shock

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