title: The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study).
abstract: BACKGROUND
  Despite evidence demonstrating the value of performance initiatives, marked differences remain between hospitals in the delivery of care for patients with sepsis. The aims of this study were to improve our understanding of how compliance with the 3-h and 6-h Surviving Sepsis Campaign (SSC) bundles are used in different geographic areas, and how this relates to outcome.
  
  
  METHODS
  This was a global, prospective, observational, quality improvement study of compliance with the SSC bundles in patients with either severe sepsis or septic shock.
  
  
  RESULTS
  A total of 1794 patients from 62 countries were enrolled in the study with either severe sepsis or septic shock. Overall compliance with all the 3-h bundle metrics was 19%. This was associated with lower hospital mortality than non-compliance (20 vs. 31%, p < 0.001). Overall compliance with all the 6-h bundle metrics was 36%. This was associated with lower hospital mortality than non-compliance (22 vs. 32%, p < 0.001). After adjusting the crude mortality differences for ICU admission, sepsis status (severe sepsis or septic shock), location of diagnosis, APACHE II score and country, compliance remained independently associated with improvements in hospital mortality for both the 3-h bundle (OR = 0.64 (95% CI 0.47-0.87), p = 0.004)) and 6-h bundle (OR = 0.71 (95% CI 0.56-0.90), p = 0.005)).
  
  
  CONCLUSIONS
  Compliance with all of the evidence-based bundle metrics was not high. Patients whose care included compliance with all of these metrics had a 40% reduction in the odds of dying in hospital with the 3-h bundle and 36% for the 6-h bundle.
authors.affiliation: Department of Intensive Care Medicine, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK, andrewrhodes@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: Gary
authors.initials: G
authors.lastname: Phillips
authors.forename: Richard
authors.initials: R
authors.lastname: Beale
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
authors.forename: Jean Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Jigeeshu
authors.initials: J
authors.lastname: Divatia
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Laura
authors.initials: L
authors.lastname: Evans
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
authors.forename: Despoina
authors.initials: D
authors.lastname: Koulenti
authors.forename: Flavia
authors.initials: F
authors.lastname: Machado
authors.forename: Steven Q
authors.initials: SQ
authors.lastname: Simpson
authors.forename: Cheng Cheng
authors.initials: CC
authors.lastname: Tan
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
mesh_terms: D000368:Aged; D006293:Health Promotion; D017052:Hospital Mortality; D006801:Humans; D038622:Internationality; D008875:Middle Aged; D064872:Patient Care Bundles; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate