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Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia.

Authors
 Sungwon Na  ;  Win Sen Kuan  ;  Malcolm Mahadevan  ;  Chih-Huang Li  ;  Pinak Shrikhande  ;  Sumit Ray  ;  Michael Batech  ;  H. Bryant Nguyen 
Citation
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol.24(5) : 452-462, 2012 
Journal Title
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 
ISSN
 1353-4505 
Issue Date
2012
MeSH
APACHE ; Aged ; Asia ; Female ; Guideline Adherence/statistics & numerical data* ; Hospital Mortality ; Hospitals, Urban/standards ; Hospitals, Urban/statistics & numerical data ; Humans ; Length of Stay ; Male ; Middle Aged ; Patient Care Team/organization & administration ; Practice Guidelines as Topic* ; Prospective Studies ; Resuscitation/methods* ; Resuscitation/standards* ; Sepsis/mortality ; Sepsis/therapy* ; Shock, Septic/mortality ; Shock, Septic/therapy ; Time Factors
Keywords
severe sepsis ; septic shock ; severe sepsis resuscitation bundle ; early goal-directed therapy
Abstract
OBJECTIVE: To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care. DESIGN: Prospective cohort study. SETTING: Eight urban hospitals, five countries in Asia. PARTICIPANTS: Adult patients with severe sepsis or septic shock. INTERVENTIONS: Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles. MAIN OUTCOME MEASURES: Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model. METHODS: In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care. RESULTS: Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables. CONCLUSIONS: Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model.
Full Text
http://intqhc.oxfordjournals.org/content/24/5/452
DOI
22899698
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90432
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