학술논문
Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study
Document Type
article
Author
Gianpaola Monti; Emanuele Rezoagli; Angelo Calini; Alice Nova; Silvia Marchesi; Giovanni Nattino; Greta Carrara; Sergio Morra; Francesca Cortellaro; Monica Savioli; Federico Capra Marzani; Moreno Tresoldi; Paolo Villa; Stefano Greco; Paolo Bonfanti; Maria Grazia Spitoni; Sergio Vesconi; Pietro Caironi; Roberto Fumagalli; “Lotta alla Sepsi” Team Study Group; M. Aceti; M. Alborghetti; E. Beck; W. Bonalume; M. Bornaghi; S. Bosisio; E. Brusa; V. Canegrati; R. Capra; A. Cecchin; S. Ciccone; M. De Lucia; G. Erhan; C. Fabbri; L. Ferrante; N. Ferrari; S. Franchini; G. Gallotta; P. Galotti; P. Gavazzi; D. Grassi; M. Lattuada; C. Lorini; L. Manin; G. Marchesi; F. Margarito; F. Martini; M. Meo; G. Minoja; M. Ortolan; M. Padovani; M. Pecorino; A. Quaini; S. Quarteroni; D. Radrizzani; M. Ranzini; T. Santambrogio; V. Savojardo; A. Sciascera; G. Serra; M. Tajè; F. Tengattin; T. Tira; B. Tonolli; R. Traficante; M. Tresoldi; E. Varisco; M. Zarienato; C. Zeroli
Source
Frontiers in Medicine, Vol 10 (2023)
Subject
Language
English
ISSN
2296-858X
Abstract
ObjectiveSepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a “simplified 1-h bundle” (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU).MethodsEmergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort).Measurements and main resultsThe effect of QIP on bundle compliance and hospital mortality was evaluated in a before–after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the “simplified rapid (1 h) intervention bundle” (the Sepsis 6 bundle – S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p