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.
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.
Authors: Frank Bloos; Hendrik Rüddel; Daniel Thomas-Rüddel; Daniel Schwarzkopf; Christine Pausch; Stephan Harbarth; Torsten Schreiber; Matthias Gründling; John Marshall; Philipp Simon; Mitchell M Levy; Manfred Weiss; Andreas Weyland; Herwig Gerlach; Tobias Schürholz; Christoph Engel; Claudia Matthäus-Krämer; Christian Scheer; Friedhelm Bach; Reimer Riessen; Bernhard Poidinger; Karin Dey; Norbert Weiler; Andreas Meier-Hellmann; Helene H Häberle; Gabriele Wöbker; Udo X Kaisers; Konrad Reinhart Journal: Intensive Care Med Date: 2017-05-02 Impact factor: 17.440
Authors: C Metelmann; B Metelmann; C Scheer; M Gründling; B Henkel; K Hahnenkamp; P Brinkrolf Journal: Anaesthesist Date: 2018-05-25 Impact factor: 1.041
Authors: D C Richter; A Heininger; T Brenner; M Hochreiter; M Bernhard; J Briegel; S Dubler; B Grabein; A Hecker; W A Kruger; K Mayer; M W Pletz; D Storzinger; N Pinder; T Hoppe-Tichy; S Weiterer; S Zimmermann; A Brinkmann; M A Weigand; C Lichtenstern Journal: Anaesthesist Date: 2019-02 Impact factor: 1.041
Authors: D C Richter; A Heininger; T Brenner; M Hochreiter; M Bernhard; J Briegel; S Dubler; B Grabein; A Hecker; W A Krüger; K Mayer; M W Pletz; D Störzinger; N Pinder; T Hoppe-Tichy; S Weiterer; S Zimmermann; A Brinkmann; M A Weigand; Christoph Lichtenstern Journal: Anaesthesist Date: 2017-10 Impact factor: 1.041
Authors: Daniel Schwarzkopf; Hendrik Rüddel; Matthias Gründling; Christian Putensen; Konrad Reinhart Journal: Implement Sci Date: 2018-01-18 Impact factor: 7.327