title: A multifaceted intervention  to improve sepsis management  in general hospital wards with  evaluation using segmented  regression of interrupted time series.
abstract: OBJECTIVE
  Antibiotic administration to inpatients developing sepsis in general hospital wards was frequently delayed. We aimed to reproduce improvements in sepsis management reported in other settings.
  
  
  BACKGROUND
  Ninewells Hospital, an 860-bed teaching hospital with quality improvement (QI) experience, in Scotland, UK. The intervention wards were 22 medical, surgical and orthopaedic inpatient wards.
  
  
  METHODS
  A multifaceted intervention, informed by baseline process data and questionnaires and interviews with junior doctors, evaluated using segmented regression analysis of interrupted time series (ITS) data. MEASURES FOR IMPROVEMENT: Primary outcome measure: antibiotic administration within 4 hours of sepsis onset. Secondary measures: antibiotics within 8 hours; mean and median time to antibiotics; medical review within 30 min for patients with a standardised early warning system score .4; blood cultures taken before antibiotic administration; blood lactate level measured.
  
  
  METHODS
  The intervention included printed and electronic clinical guidance, educational clinical team meetings including baseline performance data, audit and monthly feedback on performance.
  
  
  RESULTS
  Performance against all study outcome measures improved postintervention but differences were small and ITS analysis did not attribute the observed changes to the intervention.
  
  
  CONCLUSIONS
  Rigorous analysis of this carefully designed improvement intervention could not confirm significant effects. Statistical analysis of many such studies is inadequate, and there is insufficient reporting of negative studies. In light of recent evidence, involving senior clinical team members in verbal feedback and action planning may have made the intervention more effective. Our focus on rigorous intervention design and evaluation was at the expense of iterative refinement, which likely reduced the effect. This highlights the necessary, but challenging, requirement to invest in all three components for effective QI.
authors.forename: Charis A
authors.initials: CA
authors.lastname: Marwick
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.forename: Jan E C
authors.initials: JE
authors.lastname: Pringle
authors.forename: Josie M M
authors.initials: JM
authors.lastname: Evans
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.forename: Peter T
authors.initials: PT
authors.lastname: Donnan
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019468:Disease Management; D005246:Feedback; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D065186:Interrupted Time Series Analysis; D007407:Interviews as Topic; D010043:Outcome and Process Assessment, Health Care; D010362:Patients' Rooms; D058996:Quality Improvement; D012606:Scotland; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents