Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia
Journal
International Journal for Quality in Health Care
Journal Volume
24
Journal Issue
5
Pages
452-462
Date Issued
2012
Author(s)
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.
Tyagi N.
Yiming L.
Ying Z.
Abstract
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.
SDGs
Other Subjects
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
Type
journal article