The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

By Mitchell M. Levy, R. Dellinger, S. Townsend, W. Linde‐Zwirble, J. Marshall, J. Bion, C. Schorr, Antonio Artigas, G. Ramsay, Richard J. Beale and 6 more. Intensive Care Medicine, 2010

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ObjectiveThe 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 on process improvement and patient outcomes.Design and settingA multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008.Main resultsData 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 years (P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). 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 years (P = 0.001). 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 5.4% over 2 years (95% CI, 2.5–8.4%).ConclusionsThe 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.

Subfields: Critical Care and Intensive Care Medicine, Epidemiology

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Citations in the corpus

Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007 (2012, background): “57 Death 154,159 (37) 174337 (35) 190,003 (34) 201,627 (32) 207,427 (29) .”
Sepsis and septic shock. (2018, background): “36,45 Effective treatment should focus on timely intervention, including removal of the source of infection.”
Effect of eritoran, an antagonist of MD2-TLR4, on mortality in patients with severe sepsis: the ACCESS randomized trial. (2013, methodology): “The Surviving Sepsis Campaign reported decreased mortality based on improved supportive care and evidencebased guidelines for diagnosis and timely intervention.(4,5) However, mortality remains at approximately 30%(4) and hospital admissions for severe sepsis have increased.”
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 (2013, methodology): “adherence to CVP and ScvO2 targets for initial resuscitation was low [15].”
The Pathogenesis of Sepsis (2011, methodology): “A recent review of multiple centers demonstrated a decrease in mortality associated with increased compliance with the guidelines (81).”
Persistent inflammation and immunosuppression: A common syndrome and new horizon for surgical intensive care (2012, background): “Recent audits have shown surprisingly low compliance with widely accepted EBGs, and substantial improvement in outcomes by strategies that only modestly improve compliance.(16,21) One approach that has consistently demonstrated improved implementation of evidence-based care and patient outcome is co”
From vital signs to clinical outcomes for patients with sepsis: a machine learning basis for a clinical decision support system (2014, background): “…lacks speci ﬁ city (SP) (4.6 – 12.9% 25 Compliance with the guideline for severe sepsis improves patient outcomes in disparate clinical settings, 26 27 but the burden of screening large numbers of patients for hyperlactate-mia has been reported as a signi ﬁ cant barrier to compliance.”