https://scholars.lib.ntu.edu.tw/handle/123456789/526685
標題: | Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia | 作者: | Na S. Kuan W.S. Mahadevan M. Li C.-H. Shrikhande P. Ray S. Batech M. Bryant Nguyen H. Varma A. Joshi M. Subhan I. SHYR-CHYR CHEN Tyagi N. Yiming L. Ying Z. |
公開日期: | 2012 | 卷: | 24 | 期: | 5 | 起(迄)頁: | 452-462 | 來源出版物: | International Journal for Quality in Health Care | 摘要: | Objectives: To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care. Design: Prospective cohort study. Setting: Eight urban hospitals, five countries in Asia. Participants: Adult patients with severe sepsis or septic shock. Interventions: Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles. Main outcome measures: Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model. Methods: In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care. Results: Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables. Conclusions: Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model. ? The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/526685 | ISSN: | 1353-4505 | DOI: | 10.1093/intqhc/mzs045 | SDG/關鍵字: | adult; aged; article; Asia; disease severity; early goal directed therapy; emergency physician; emergency ward; female; health care planning; human; intensive care unit; major clinical study; male; mortality; patient care; patient compliance; priority journal; prospective study; resuscitation; sepsis; septic shock; survival rate; total quality management; Aged; APACHE; Asia; Female; Guideline Adherence; Hospital Mortality; Hospitals, Urban; Humans; Length of Stay; Male; Middle Aged; Patient Care Team; Practice Guidelines as Topic; Prospective Studies; Resuscitation; Sepsis; Shock, Septic; Time Factors |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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