The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis*

Abstract

Objective: The Surviving Sepsis Campaign (SSC or ''the Campaign'') developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted Intensive Care Med (2010) 36:222-231 DOI 10.1007/s00134-009-1738 ORIGINAL changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. Design and setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were ''bundled'' into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. Main results: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P \ 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5-8.4%). Conclusions: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…The early identification of sepsis and implementation of early therapies have been documented to improve outcomes and decrease sepsis-related mortality [49]. Reducing the time to diagnosis of severe sepsis is thought to be a critical component of reducing mortality from sepsis-related multiple organ dysfunction [50].…”

“…If an infectious cause of fever is suspected, empirical antimicrobial therapy is urgent. Indeed, delaying effective antimicrobial therapy has been associated with increased mortality [49,[110][111][112][113][114]. Barie and associates [115] demonstrated in a prospective observational study that the delayed-antibiotic therapy increased the risk of death by 2.1% for every 30 minutes' delay (OR, 1.021; 95% CI, 1.003 to 1.038).…”

Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

“…The SSC protocol includes the most up-to-date and advanced therapeutic interventions to be implemented in two bundles: a 6-h resuscitation bundle, including lactate determination, early cultures and antibiotics, and early goal-directed therapy, and a 24-h management bundle, including optimizing glycemia and plateau pressure and considering treatment with corticoids and/or drotrecogin alfa (activated). An international study evaluating the implementation of the SSC protocol showed that the campaign was associated with sustained, continuous quality improvement in sepsis care, and with a reduction in reported hospital mortality rates [8]. In Spain, the SSC protocol was introduced by means of a 2-month educational program.…”

Adherencia a las guías internacionales de manejo temprano en sepsis grave y choque séptico

“…Los resultados de este programa muestran cómo, en un periodo de dos años, la observancia inicial del conjunto de medidas de reanimación mejoró de 10,5 % a 31,3 %, aumento que parece asociarse con una reducción en la mortalidad (20).…”