title: Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units.
abstract: OBJECTIVE
  The reported actual compliance for severe sepsis bundles was very low, suggesting the presence of barriers to their implementation. The purpose of this study was to assess the influence of full-time intensivist and nurse-to-patient ratio in Korean intensive care units (ICUs) on the implementation of the severe sepsis bundles and clinical outcome.
  
  
  METHODS
  A total of 251 patients with severe sepsis were enrolled from 28 adult ICUs during the July, 2009. We recorded the organizational characteristics of ICUs, patients' characteristics and clinical outcomes, and the compliance for severe sepsis bundles.
  
  
  RESULTS
  Complete compliance with the resuscitation bundle and totally complete compliance with all element targets for resuscitation and management bundles were significantly higher in the ICU with full-time intensivist and a nurse-to-patient ratio of 1:2 (P < .05). The hazard ratio (HR) for hospital mortality was independently reduced by the presence of full-time intensivist (HR, 0.456; 95% confidence interval, 0.223-0.932), and a nurse-to-patient ratio of 1:2 was independently associated with a lower 28-day mortality (HR, 0.459; 95% confidence interval, 0.211-0.998).
  
  
  CONCLUSIONS
  The full-time intensivist and the nurse-to-patient ratio had a substantial influence on the implementation of severe sepsis bundles and the mortalities of patients with severe sepsis.
authors.affiliation: Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, 425-707 Republic of Korea.
authors.forename: Je Hyeong
authors.initials: JH
authors.lastname: Kim
authors.forename: Suk-Kyung
authors.initials: SK
authors.lastname: Hong
authors.forename: Kyung Chan
authors.initials: KC
authors.lastname: Kim
authors.forename: Myung-Goo
authors.initials: MG
authors.lastname: Lee
authors.forename: Ki Man
authors.initials: KM
authors.lastname: Lee
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Jung
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Choi
authors.forename: Jin Hwa
authors.initials: JH
authors.lastname: Lee
authors.forename: Ki-Suk
authors.initials: KS
authors.lastname: Jung
authors.forename: Sung-Soon
authors.initials: SS
authors.lastname: Lee
authors.forename: Jae Hwa
authors.initials: JH
authors.lastname: Cho
authors.forename: Shin Ok
authors.initials: SO
authors.lastname: Koh
authors.forename: Moo Suk
authors.initials: MS
authors.lastname: Park
authors.forename: Kwang Won
authors.initials: KW
authors.lastname: Seo
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data; D056910:Republic of Korea; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*