Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study
OBJECTIVE:To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated. DESIGN:Prospect...
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| Veröffentlicht in: | Critical care medicine 2017-02, Vol.45 (2), p.241-252 |
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| creator | Scheer, Christian S. Fuchs, Christian Kuhn, Sven-Olaf Vollmer, Marcus Rehberg, Sebastian Friesecke, Sigrun Abel, Peter Balau, Veronika Bandt, Christoph Meissner, Konrad Hahnenkamp, Klaus Gründling, Matthias |
| description | OBJECTIVE:To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated.
DESIGN:Prospective observational before-after cohort study.
SETTING:Tertiary university hospital in Germany.
PATIENTS:All adult medical and surgical ICU patients with severe sepsis and septic shock.
INTERVENTION:Implementation of a quality improvement program over 7.5 years.
MEASUREMENTS:The primary endpoint was 90-day mortality. Secondary endpoints included ICU and hospital mortality rates and length of stay, time to broad-spectrum antiinfective therapy, and compliance with resuscitation bundle elements.
MAIN RESULTS:A total of 14,115 patients were screened. The incidence of severe sepsis and septic shock was 9.7%. Ninety-day mortality decreased from 64.2% to 45.0% (p < 0.001). Hospital length of stay decreased from 44 to 36 days (p < 0.05). Compliance with resuscitation bundle elements was significantly improved. Antibiotic therapy within the first hour after sepsis onset increased from 48.5% to 74.3% (p < 0.001). Multivariate analysis revealed blood cultures before antibiotic therapy (hazard ratio, 0.60–0.84; p < 0.001), adequate calculated antibiotic therapy (hazard ratio, 0.53–0.75; p < 0.001), 1–2 L crystalloids within the first 6 hours (hazard ratio 0.67–0.97; p = 0.025), and greater than or equal to 6 L during the first 24 hours (hazard ratio, 0.64–0.95; p = 0.012) as predictors for improved survival.
CONCLUSIONS:The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered. |
| doi_str_mv | 10.1097/CCM.0000000000002069 |
| format | Article |
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DESIGN:Prospective observational before-after cohort study.
SETTING:Tertiary university hospital in Germany.
PATIENTS:All adult medical and surgical ICU patients with severe sepsis and septic shock.
INTERVENTION:Implementation of a quality improvement program over 7.5 years.
MEASUREMENTS:The primary endpoint was 90-day mortality. Secondary endpoints included ICU and hospital mortality rates and length of stay, time to broad-spectrum antiinfective therapy, and compliance with resuscitation bundle elements.
MAIN RESULTS:A total of 14,115 patients were screened. The incidence of severe sepsis and septic shock was 9.7%. Ninety-day mortality decreased from 64.2% to 45.0% (p < 0.001). Hospital length of stay decreased from 44 to 36 days (p < 0.05). Compliance with resuscitation bundle elements was significantly improved. Antibiotic therapy within the first hour after sepsis onset increased from 48.5% to 74.3% (p < 0.001). Multivariate analysis revealed blood cultures before antibiotic therapy (hazard ratio, 0.60–0.84; p < 0.001), adequate calculated antibiotic therapy (hazard ratio, 0.53–0.75; p < 0.001), 1–2 L crystalloids within the first 6 hours (hazard ratio 0.67–0.97; p = 0.025), and greater than or equal to 6 L during the first 24 hours (hazard ratio, 0.64–0.95; p = 0.012) as predictors for improved survival.
CONCLUSIONS:The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000002069</identifier><identifier>PMID: 27661863</identifier><language>eng</language><publisher>United States: by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Aged ; Female ; Hospital Mortality ; Humans ; Length of Stay ; Male ; Middle Aged ; Patient Care Bundles ; Prospective Studies ; Quality Improvement ; Resuscitation - methods ; Resuscitation - standards ; Sepsis - mortality ; Sepsis - therapy ; Shock, Septic - mortality ; Shock, Septic - therapy</subject><ispartof>Critical care medicine, 2017-02, Vol.45 (2), p.241-252</ispartof><rights>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4679-1e60bbc1afd7ebb39f9173b53b169b2d9730866414de00467d3ec8fe17332d223</citedby><cites>FETCH-LOGICAL-c4679-1e60bbc1afd7ebb39f9173b53b169b2d9730866414de00467d3ec8fe17332d223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27661863$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scheer, Christian S.</creatorcontrib><creatorcontrib>Fuchs, Christian</creatorcontrib><creatorcontrib>Kuhn, Sven-Olaf</creatorcontrib><creatorcontrib>Vollmer, Marcus</creatorcontrib><creatorcontrib>Rehberg, Sebastian</creatorcontrib><creatorcontrib>Friesecke, Sigrun</creatorcontrib><creatorcontrib>Abel, Peter</creatorcontrib><creatorcontrib>Balau, Veronika</creatorcontrib><creatorcontrib>Bandt, Christoph</creatorcontrib><creatorcontrib>Meissner, Konrad</creatorcontrib><creatorcontrib>Hahnenkamp, Klaus</creatorcontrib><creatorcontrib>Gründling, Matthias</creatorcontrib><title>Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated.
DESIGN:Prospective observational before-after cohort study.
SETTING:Tertiary university hospital in Germany.
PATIENTS:All adult medical and surgical ICU patients with severe sepsis and septic shock.
INTERVENTION:Implementation of a quality improvement program over 7.5 years.
MEASUREMENTS:The primary endpoint was 90-day mortality. Secondary endpoints included ICU and hospital mortality rates and length of stay, time to broad-spectrum antiinfective therapy, and compliance with resuscitation bundle elements.
MAIN RESULTS:A total of 14,115 patients were screened. The incidence of severe sepsis and septic shock was 9.7%. Ninety-day mortality decreased from 64.2% to 45.0% (p < 0.001). Hospital length of stay decreased from 44 to 36 days (p < 0.05). Compliance with resuscitation bundle elements was significantly improved. Antibiotic therapy within the first hour after sepsis onset increased from 48.5% to 74.3% (p < 0.001). Multivariate analysis revealed blood cultures before antibiotic therapy (hazard ratio, 0.60–0.84; p < 0.001), adequate calculated antibiotic therapy (hazard ratio, 0.53–0.75; p < 0.001), 1–2 L crystalloids within the first 6 hours (hazard ratio 0.67–0.97; p = 0.025), and greater than or equal to 6 L during the first 24 hours (hazard ratio, 0.64–0.95; p = 0.012) as predictors for improved survival.
CONCLUSIONS:The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered.</description><subject>Aged</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Care Bundles</subject><subject>Prospective Studies</subject><subject>Quality Improvement</subject><subject>Resuscitation - methods</subject><subject>Resuscitation - standards</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1vEzEQhi1ERdPAP0DIRy4bxvauveZWpXxEalVB4MBpZa9nlaX7EWxvqvDr65BSoR7oXGYO7_OO5h1CXjNYMNDq3XJ5tYB_ioPUz8iMFQIy4Fo8JzMADZnItTglZyH8BGB5ocQLcsqVlKyUYkZ-f5lM18Y9XfVbP-6wxyHS1dDG1sR2h7QZPV3jDj2mtg1toGZwhzG2NV1vxvqGfkU31Rho2nVh9vRq9PGP5Xt6TtWiyH6g8fTaBvS75DkOpqPrOLn9S3LSmC7gq_s-J98_fvi2_JxdXn9aLc8vszqXSmcMJVhbM9M4hdYK3WimhC2EZVJb7rQSUEqZs9whQEKcwLpsMIkEd5yLOXl79E0H_powxKpvQ41dZwYcp1CxstAqB54ym5P8KK39GILHptr6tjd-XzGoDqlXKfXqceoJe3O_YbI9ugfob8xJUB4Ft2MX0YebbrpFX23QdHHzlHf-H_QgEzyXGQemEgDp9-nNXNwBNjCc-Q</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Scheer, Christian S.</creator><creator>Fuchs, Christian</creator><creator>Kuhn, Sven-Olaf</creator><creator>Vollmer, Marcus</creator><creator>Rehberg, Sebastian</creator><creator>Friesecke, Sigrun</creator><creator>Abel, Peter</creator><creator>Balau, Veronika</creator><creator>Bandt, Christoph</creator><creator>Meissner, Konrad</creator><creator>Hahnenkamp, Klaus</creator><creator>Gründling, Matthias</creator><general>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170201</creationdate><title>Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study</title><author>Scheer, Christian S. ; Fuchs, Christian ; Kuhn, Sven-Olaf ; Vollmer, Marcus ; Rehberg, Sebastian ; Friesecke, Sigrun ; Abel, Peter ; Balau, Veronika ; Bandt, Christoph ; Meissner, Konrad ; Hahnenkamp, Klaus ; Gründling, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4679-1e60bbc1afd7ebb39f9173b53b169b2d9730866414de00467d3ec8fe17332d223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Care Bundles</topic><topic>Prospective Studies</topic><topic>Quality Improvement</topic><topic>Resuscitation - methods</topic><topic>Resuscitation - standards</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scheer, Christian S.</creatorcontrib><creatorcontrib>Fuchs, Christian</creatorcontrib><creatorcontrib>Kuhn, Sven-Olaf</creatorcontrib><creatorcontrib>Vollmer, Marcus</creatorcontrib><creatorcontrib>Rehberg, Sebastian</creatorcontrib><creatorcontrib>Friesecke, Sigrun</creatorcontrib><creatorcontrib>Abel, Peter</creatorcontrib><creatorcontrib>Balau, Veronika</creatorcontrib><creatorcontrib>Bandt, Christoph</creatorcontrib><creatorcontrib>Meissner, Konrad</creatorcontrib><creatorcontrib>Hahnenkamp, Klaus</creatorcontrib><creatorcontrib>Gründling, Matthias</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scheer, Christian S.</au><au>Fuchs, Christian</au><au>Kuhn, Sven-Olaf</au><au>Vollmer, Marcus</au><au>Rehberg, Sebastian</au><au>Friesecke, Sigrun</au><au>Abel, Peter</au><au>Balau, Veronika</au><au>Bandt, Christoph</au><au>Meissner, Konrad</au><au>Hahnenkamp, Klaus</au><au>Gründling, Matthias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>45</volume><issue>2</issue><spage>241</spage><epage>252</epage><pages>241-252</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract>OBJECTIVE:To investigate the impact of a quality improvement initiative for severe sepsis and septic shock focused on the resuscitation bundle on 90-day mortality. Furthermore, effects on compliance rates for antiinfective therapy within the recommended 1-hour interval are evaluated.
DESIGN:Prospective observational before-after cohort study.
SETTING:Tertiary university hospital in Germany.
PATIENTS:All adult medical and surgical ICU patients with severe sepsis and septic shock.
INTERVENTION:Implementation of a quality improvement program over 7.5 years.
MEASUREMENTS:The primary endpoint was 90-day mortality. Secondary endpoints included ICU and hospital mortality rates and length of stay, time to broad-spectrum antiinfective therapy, and compliance with resuscitation bundle elements.
MAIN RESULTS:A total of 14,115 patients were screened. The incidence of severe sepsis and septic shock was 9.7%. Ninety-day mortality decreased from 64.2% to 45.0% (p < 0.001). Hospital length of stay decreased from 44 to 36 days (p < 0.05). Compliance with resuscitation bundle elements was significantly improved. Antibiotic therapy within the first hour after sepsis onset increased from 48.5% to 74.3% (p < 0.001). Multivariate analysis revealed blood cultures before antibiotic therapy (hazard ratio, 0.60–0.84; p < 0.001), adequate calculated antibiotic therapy (hazard ratio, 0.53–0.75; p < 0.001), 1–2 L crystalloids within the first 6 hours (hazard ratio 0.67–0.97; p = 0.025), and greater than or equal to 6 L during the first 24 hours (hazard ratio, 0.64–0.95; p = 0.012) as predictors for improved survival.
CONCLUSIONS:The continuous quality improvement initiative focused on the resuscitation bundle was associated with increased compliance and a persistent reduction in 90-day mortality over a 7.5-year period. Based on the observational study design, a causal relationship cannot be proven, and respective limitations need to be considered.</abstract><cop>United States</cop><pub>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>27661863</pmid><doi>10.1097/CCM.0000000000002069</doi><tpages>12</tpages></addata></record> |
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| ispartof | Critical care medicine, 2017-02, Vol.45 (2), p.241-252 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Aged Female Hospital Mortality Humans Length of Stay Male Middle Aged Patient Care Bundles Prospective Studies Quality Improvement Resuscitation - methods Resuscitation - standards Sepsis - mortality Sepsis - therapy Shock, Septic - mortality Shock, Septic - therapy |
| title | Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study |
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