The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis
The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis
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DOI：
10.1097/ccm.0b013e3181cb0cdc
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发表时间：
2010-02-01
影响因子：
8.8
通讯作者：
Angus, Derek C.
中科院分区：
文献类型：
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作者：
Levy, Mitchell M.;Dellinger, R. Phillip;Angus, Derek C.
目的：脓毒症生存运动（SSC或“运动”）制定了严重脓毒症和脓毒性休克管理指南。一项绩效改进计划旨在通过基于关键SSC指南建议的捆绑来改变临床行为（流程改进）。设计和设置：在美国、欧洲和南美洲自愿实施多方面干预，以促进重症监护室急诊科、个别医院病房和区域医院网络中选择的指南建议的依从性。准则的要素被“捆绑”成两套目标，分别在6小时和24小时内完成。对2005年1月至2008年3月提交的数据进行分析。受试者：共15，022名受试者。测量和主要结果：分析了来自165个地点的15，022名受试者的数据，以确定对捆绑目标的依从性和与医院死亡率的相关性。对整个复苏束的依从性从第一个研究中心季度的10.9%线性增加到2年末的31.3%（p < .0001）。整个管理包的合规性从第一季度的18.4%开始，到2年末增加到36.1%（p = 0.008）。除了吸气平台压在基线时较高外，所有束元素的顺应性均显著增加。2年内未校正的住院死亡率从37%降至30.8%（p = 0.001）。调整后的优势比死亡率提高了较长的一个网站是在运动，导致调整后的绝对下降0.8%，每季度和5.40%，超过2 yrs（95%置信区间，2.5-8.4）。结论：运动与持续，持续的质量改善脓毒症护理。虽然不一定是因果关系，但报告的住院死亡率降低与参与有关。这项研究的影响，可以作为类似的改进工作的动力。(Crit Care Med 2010; 38：367-374）
Objective: The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations.Design and Setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the intensive care unit emergency department, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the United States, Europe, and South America. Elements of the guidelines were "bundled" into two sets of targets to be completed within 6 hrs and within 24 hrs. An analysis was conducted on data submitted from January 2005 through March 2008.Subjects: A total of 15,022 subjects.Measurements and Main Results: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 yrs (p < .0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 yrs (p = .008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37% to 30.8% over 2 yrs (p = .001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.40% over 2 yrs (95% confidence interval, 2.5-8.4).Conclusions: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts. (Crit Care Med 2010; 38:367-374)