Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain
CONTEXT Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected proces...
Gespeichert in:
| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2008-05, Vol.299 (19), p.2294-2303 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2303 |
|---|---|
| container_issue | 19 |
| container_start_page | 2294 |
| container_title | JAMA : the journal of the American Medical Association |
| container_volume | 299 |
| creator | Ferrer, Ricard Artigas, Antonio Levy, Mitchell M Blanco, Jesús González-Díaz, Gumersindo Garnacho-Montero, José Ibáñez, Jordi Palencia, Eduardo Quintana, Manuel de la Torre-Prados, María Victoria Edusepsis Study Group, for the |
| description | CONTEXT Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis. DESIGN, SETTING, AND PATIENTS Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs. INTERVENTION The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours). MAIN OUTCOME MEASURES Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay. RESULTS Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P |
| doi_str_mv | 10.1001/jama.299.19.2294 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_70773794</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>181913</ama_id><sourcerecordid>20886744</sourcerecordid><originalsourceid>FETCH-LOGICAL-a440t-8c632b1cdee7aed4c784c777159a7f0d3e932aea32779c8e4efdbd0b818623fe3</originalsourceid><addsrcrecordid>eNqF0c9LwzAUB_AgipvTu14kePDWml9bkuMYUweTCdNzeUtfpaM_ZtMO_O9N2QTxYuARQj7vCy8h5JqzmDPGH7ZQQiysjbmNhbDqhAz5WJpIjq05JUPGrIm0MmpALrzfsrC41OdkwI2ywmo-JPmi3DX1HkusWppX9LWpHXpP64zOoEEKVUpXXevqEuk0a7GhQF-6os1daAinNe4xsDXufO7pPO0ctHldQdEnfTRQ9qHrHeTVJTnLoPB4ddxH5P1x_jZ7jparp8VsuoxAKdZGxk2k2HCXImrAVDltQmnNxxZ0xlKJVgpAkEJr6wwqzNJNyjaGm4mQGcoRuT_khrk-O_RtUubeYVFAhXXnE820ltqqf6Fgxky06uHdH7ituybMGAzn0iqme3R7RN2mxDTZNXkJzVfy89QB3BxA-LNft9xyKb8BcEmJOw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211394074</pqid></control><display><type>article</type><title>Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Ferrer, Ricard ; Artigas, Antonio ; Levy, Mitchell M ; Blanco, Jesús ; González-Díaz, Gumersindo ; Garnacho-Montero, José ; Ibáñez, Jordi ; Palencia, Eduardo ; Quintana, Manuel ; de la Torre-Prados, María Victoria ; Edusepsis Study Group, for the</creator><creatorcontrib>Ferrer, Ricard ; Artigas, Antonio ; Levy, Mitchell M ; Blanco, Jesús ; González-Díaz, Gumersindo ; Garnacho-Montero, José ; Ibáñez, Jordi ; Palencia, Eduardo ; Quintana, Manuel ; de la Torre-Prados, María Victoria ; Edusepsis Study Group, for the ; Edusepsis Study Group</creatorcontrib><description>CONTEXT Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis. DESIGN, SETTING, AND PATIENTS Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs. INTERVENTION The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours). MAIN OUTCOME MEASURES Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay. RESULTS Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P < .001) and in the sepsis management bundle (10.9% [95% CI, 9%-13%] vs 15.7% [95% CI, 14%-18%]; P = .001). Hospital length of stay and ICU length of stay did not change after the intervention. During long-term follow-up, compliance with the sepsis resuscitation bundle returned to baseline but compliance with the sepsis management bundle and mortality remained stable with respect to the postintervention period. CONCLUSIONS A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.299.19.2294</identifier><identifier>PMID: 18492971</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Blood diseases ; Clinical outcomes ; Female ; Guideline Adherence ; Hospital Mortality ; Hospitalization ; Humans ; Inservice Training ; Intensive care ; Intensive Care Units - standards ; Intensive Care Units - statistics & numerical data ; Length of Stay ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Patient education ; Practice Guidelines as Topic ; Sepsis - mortality ; Sepsis - therapy ; Severity of Illness Index ; Shock, Septic - mortality ; Shock, Septic - therapy ; Spain</subject><ispartof>JAMA : the journal of the American Medical Association, 2008-05, Vol.299 (19), p.2294-2303</ispartof><rights>Copyright American Medical Association May 21, 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a440t-8c632b1cdee7aed4c784c777159a7f0d3e932aea32779c8e4efdbd0b818623fe3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.299.19.2294$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.299.19.2294$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18492971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferrer, Ricard</creatorcontrib><creatorcontrib>Artigas, Antonio</creatorcontrib><creatorcontrib>Levy, Mitchell M</creatorcontrib><creatorcontrib>Blanco, Jesús</creatorcontrib><creatorcontrib>González-Díaz, Gumersindo</creatorcontrib><creatorcontrib>Garnacho-Montero, José</creatorcontrib><creatorcontrib>Ibáñez, Jordi</creatorcontrib><creatorcontrib>Palencia, Eduardo</creatorcontrib><creatorcontrib>Quintana, Manuel</creatorcontrib><creatorcontrib>de la Torre-Prados, María Victoria</creatorcontrib><creatorcontrib>Edusepsis Study Group, for the</creatorcontrib><creatorcontrib>Edusepsis Study Group</creatorcontrib><title>Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis. DESIGN, SETTING, AND PATIENTS Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs. INTERVENTION The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours). MAIN OUTCOME MEASURES Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay. RESULTS Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P < .001) and in the sepsis management bundle (10.9% [95% CI, 9%-13%] vs 15.7% [95% CI, 14%-18%]; P = .001). Hospital length of stay and ICU length of stay did not change after the intervention. During long-term follow-up, compliance with the sepsis resuscitation bundle returned to baseline but compliance with the sepsis management bundle and mortality remained stable with respect to the postintervention period. CONCLUSIONS A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year.</description><subject>Aged</subject><subject>Blood diseases</subject><subject>Clinical outcomes</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Inservice Training</subject><subject>Intensive care</subject><subject>Intensive Care Units - standards</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Patient education</subject><subject>Practice Guidelines as Topic</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Severity of Illness Index</subject><subject>Shock, Septic - mortality</subject><subject>Shock, Septic - therapy</subject><subject>Spain</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c9LwzAUB_AgipvTu14kePDWml9bkuMYUweTCdNzeUtfpaM_ZtMO_O9N2QTxYuARQj7vCy8h5JqzmDPGH7ZQQiysjbmNhbDqhAz5WJpIjq05JUPGrIm0MmpALrzfsrC41OdkwI2ywmo-JPmi3DX1HkusWppX9LWpHXpP64zOoEEKVUpXXevqEuk0a7GhQF-6os1daAinNe4xsDXufO7pPO0ctHldQdEnfTRQ9qHrHeTVJTnLoPB4ddxH5P1x_jZ7jparp8VsuoxAKdZGxk2k2HCXImrAVDltQmnNxxZ0xlKJVgpAkEJr6wwqzNJNyjaGm4mQGcoRuT_khrk-O_RtUubeYVFAhXXnE820ltqqf6Fgxky06uHdH7ituybMGAzn0iqme3R7RN2mxDTZNXkJzVfy89QB3BxA-LNft9xyKb8BcEmJOw</recordid><startdate>20080521</startdate><enddate>20080521</enddate><creator>Ferrer, Ricard</creator><creator>Artigas, Antonio</creator><creator>Levy, Mitchell M</creator><creator>Blanco, Jesús</creator><creator>González-Díaz, Gumersindo</creator><creator>Garnacho-Montero, José</creator><creator>Ibáñez, Jordi</creator><creator>Palencia, Eduardo</creator><creator>Quintana, Manuel</creator><creator>de la Torre-Prados, María Victoria</creator><creator>Edusepsis Study Group, for the</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20080521</creationdate><title>Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain</title><author>Ferrer, Ricard ; Artigas, Antonio ; Levy, Mitchell M ; Blanco, Jesús ; González-Díaz, Gumersindo ; Garnacho-Montero, José ; Ibáñez, Jordi ; Palencia, Eduardo ; Quintana, Manuel ; de la Torre-Prados, María Victoria ; Edusepsis Study Group, for the</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a440t-8c632b1cdee7aed4c784c777159a7f0d3e932aea32779c8e4efdbd0b818623fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Blood diseases</topic><topic>Clinical outcomes</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Inservice Training</topic><topic>Intensive care</topic><topic>Intensive Care Units - standards</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Patient education</topic><topic>Practice Guidelines as Topic</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Severity of Illness Index</topic><topic>Shock, Septic - mortality</topic><topic>Shock, Septic - therapy</topic><topic>Spain</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrer, Ricard</creatorcontrib><creatorcontrib>Artigas, Antonio</creatorcontrib><creatorcontrib>Levy, Mitchell M</creatorcontrib><creatorcontrib>Blanco, Jesús</creatorcontrib><creatorcontrib>González-Díaz, Gumersindo</creatorcontrib><creatorcontrib>Garnacho-Montero, José</creatorcontrib><creatorcontrib>Ibáñez, Jordi</creatorcontrib><creatorcontrib>Palencia, Eduardo</creatorcontrib><creatorcontrib>Quintana, Manuel</creatorcontrib><creatorcontrib>de la Torre-Prados, María Victoria</creatorcontrib><creatorcontrib>Edusepsis Study Group, for the</creatorcontrib><creatorcontrib>Edusepsis Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrer, Ricard</au><au>Artigas, Antonio</au><au>Levy, Mitchell M</au><au>Blanco, Jesús</au><au>González-Díaz, Gumersindo</au><au>Garnacho-Montero, José</au><au>Ibáñez, Jordi</au><au>Palencia, Eduardo</au><au>Quintana, Manuel</au><au>de la Torre-Prados, María Victoria</au><au>Edusepsis Study Group, for the</au><aucorp>Edusepsis Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2008-05-21</date><risdate>2008</risdate><volume>299</volume><issue>19</issue><spage>2294</spage><epage>2303</epage><pages>2294-2303</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Concern exists that current guidelines for care of patients with severe sepsis and septic shock are followed variably, possibly due to a lack of adequate education. OBJECTIVE To determine whether a national educational program based on the Surviving Sepsis Campaign guidelines affected processes of care and hospital mortality for severe sepsis. DESIGN, SETTING, AND PATIENTS Before and after design in 59 medical-surgical intensive care units (ICUs) located throughout Spain. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the preintervention period (November-December 2005), 1465 patients during the postintervention period (March-June 2006), and 247 patients during the long-term follow-up period 1 year later (November-December 2006) in a subset of 23 ICUs. INTERVENTION The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in 2 bundles: a resuscitation bundle (6 tasks to begin immediately and be accomplished within 6 hours) and a management bundle (4 tasks to be completed within 24 hours). MAIN OUTCOME MEASURES Hospital mortality, differences in adherence to the bundles' process-of-care variables, ICU mortality, 28-day mortality, hospital length of stay, and ICU length of stay. RESULTS Patients included before and after the intervention were similar in terms of age, sex, and Acute Physiology and Chronic Health Evaluation II score. At baseline, only 3 process-of-care measurements (blood cultures before antibiotics, early administration of broad-spectrum antibiotics, and mechanical ventilation with adequate inspiratory plateau pressure) we had compliance rates higher than 50%. Patients in the postintervention cohort had a lower risk of hospital mortality (44.0% vs 39.7%; P = .04). The compliance with process-of-care variables also improved after the intervention in the sepsis resuscitation bundle (5.3% [95% confidence interval [CI], 4%-7%] vs 10.0% [95% CI, 8%-12%]; P < .001) and in the sepsis management bundle (10.9% [95% CI, 9%-13%] vs 15.7% [95% CI, 14%-18%]; P = .001). Hospital length of stay and ICU length of stay did not change after the intervention. During long-term follow-up, compliance with the sepsis resuscitation bundle returned to baseline but compliance with the sepsis management bundle and mortality remained stable with respect to the postintervention period. CONCLUSIONS A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>18492971</pmid><doi>10.1001/jama.299.19.2294</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2008-05, Vol.299 (19), p.2294-2303 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70773794 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Blood diseases Clinical outcomes Female Guideline Adherence Hospital Mortality Hospitalization Humans Inservice Training Intensive care Intensive Care Units - standards Intensive Care Units - statistics & numerical data Length of Stay Male Middle Aged Outcome and Process Assessment (Health Care) Patient education Practice Guidelines as Topic Sepsis - mortality Sepsis - therapy Severity of Illness Index Shock, Septic - mortality Shock, Septic - therapy Spain |
| title | Improvement in Process of Care and Outcome After a Multicenter Severe Sepsis Educational Program in Spain |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T18%3A19%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improvement%20in%20Process%20of%20Care%20and%20Outcome%20After%20a%20Multicenter%20Severe%20Sepsis%20Educational%20Program%20in%20Spain&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Ferrer,%20Ricard&rft.aucorp=Edusepsis%20Study%20Group&rft.date=2008-05-21&rft.volume=299&rft.issue=19&rft.spage=2294&rft.epage=2303&rft.pages=2294-2303&rft.issn=0098-7484&rft.eissn=1538-3598&rft.coden=JAMAAP&rft_id=info:doi/10.1001/jama.299.19.2294&rft_dat=%3Cproquest_pubme%3E20886744%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=211394074&rft_id=info:pmid/18492971&rft_ama_id=181913&rfr_iscdi=true |