Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia.
OBJECTIVE
To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.


METHODS
Prospective cohort study.


METHODS
Eight urban hospitals, five countries in Asia.


METHODS
Adult patients with severe sepsis or septic shock.


METHODS
Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.


METHODS
Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.


METHODS
In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care.


RESULTS
Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables.


CONCLUSIONS
Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model.
Department of Emergency Medicine and Department of Medicine, Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA 92354, USA.
Sungwon
S
Na
Win Sen
WS
Kuan
Malcolm
M
Mahadevan
Chih-Huang
CH
Li
Pinak
P
Shrikhande
Sumit
S
Ray
Michael
M
Batech
H Bryant
HB
Nguyen
D018806:APACHE; D000368:Aged; D001208:Asia; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods* / Q000592:standards*; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D013997:Time Factors