Korean J Crit Care Med.  2014 Nov;29(4):250-256. 10.4266/kjccm.2014.29.4.250.

Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study

• Kim J
• Na S
• Yoo YC
• Koh SO

• KMID: 2227731
• DOI: http://doi.org/10.4266/kjccm.2014.29.4.250

Abstract

BACKGROUND
Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock.
METHODS
Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated.
RESULTS
The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004).
CONCLUSIONS
Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.

Keyword

critical pathways; education; interdisciplinary communication; sepsis

MeSH Terms

Adult
Anti-Bacterial Agents
Compliance
Critical Pathways
Diagnosis
Education
Emergency Service, Hospital
Hemodynamics
Humans
Intensive Care Units
Interdisciplinary Communication
Mortality
Resuscitation*
Sepsis*
Shock, Septic
Anti-Bacterial Agents

Figure

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  Fig. 1. Comparison of the 28-day survival rate between the intervention and control groups. Kaplan-Meier curves depicting the probability of survival of patients with severe sepsis or septic shock in the intervention group and the control group according to the length of survival (p = 0.04 by Breslow test) + means censored data.

• 

  Fig. 2. Comparison of LOS in the ICU between the intervention and control groups. Kaplan-Meier curves depict the probability of remaining in the ICU for patients with severe sepsis or septic shock in the intervention group and the control group according to the LOS in the ICU (p = 0.001 by Log Rank test) + means censored data. LOS: length of stay; ICU: intensive care unit.

• 

  Fig. 3. Comparison of the number of days in hospital between the intervention and the control groups. Kaplan-Meier curves depict the probability of remaining in the hospital for patients with severe sepsis or septic shock in the intervention group and the control group according to the LOS in hospital (p = 0.078 by Breslow test) + means censored data. LOS: length of stay.

• 

  Fig. 4. Relationship between training and outcome. The x-axis shows the 22-month study period divided into 4-month intervals comparing the goal achievement rates between each period, and the y-axis shows the 28-day mortality rate (A) and the achievement rate of the early goal-directed resuscitation bundle (B). C indicates the time period when training was carried out.

Reference

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