title: The Surviving Sepsis Campaign: results of an  international guideline-based performance  improvement program targeting severe sepsis.
abstract: 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 on process improvement and patient outcomes.
  
  
  METHODS
  A 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.
  
  
  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 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%).
  
  
  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.
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA. Mitchell_Levy@brown.edu
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Sean R
authors.initials: SR
authors.lastname: Townsend
authors.forename: Walter T
authors.initials: WT
authors.lastname: Linde-Zwirble
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.forename: Julian
authors.initials: J
authors.lastname: Bion
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.forename: Graham
authors.initials: G
authors.lastname: Ramsay
authors.forename: Richard
authors.initials: R
authors.lastname: Beale
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Parker
authors.forename: Herwig
authors.initials: H
authors.lastname: Gerlach
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.forename: Maurene
authors.initials: M
authors.lastname: Harvey
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: 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; D017701:Reticulocyte Count; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome