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


METHODS
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.


METHODS
A total of 15,022 subjects.


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 5.4% 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.
Levy
Mitchell M
MM
Division of Pulmonary, Sleep and Critical Care Medicine Care Medicine, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA. Mitchell_Levy@brown.edu
Dellinger
R Phillip
RP
Townsend
Sean R
SR
Linde-Zwirble
Walter T
WT
Marshall
John C
JC
Bion
Julian
J
Schorr
Christa
C
Artigas
Antonio
A
Ramsay
Graham
G
Beale
Richard
R
Parker
Margaret M
MM
Gerlach
Herwig
H
Reinhart
Konrad
K
Silva
Eliezer
E
Harvey
Maurene
M
Regan
Susan
S
Angus
Derek C
DC
D016001:Confidence Intervals; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006293:Health Promotion; D017052:Hospital Mortality; D006801:Humans; D008485:Medical Audit; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome