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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2010

Open Access 01-02-2010 | Original

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

Authors: Mitchell M. Levy, R. Phillip Dellinger, Sean R. Townsend, Walter T. Linde-Zwirble, John C. Marshall, Julian Bion, Christa Schorr, Antonio Artigas, Graham Ramsay, Richard Beale, Margaret M. Parker, Herwig Gerlach, Konrad Reinhart, Eliezer Silva, Maurene Harvey, Susan Regan, Derek C. Angus

Published in: Intensive Care Medicine | Issue 2/2010

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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.

Design and setting

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.

Main 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.
Appendix
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Metadata
Title
The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis
Authors
Mitchell M. Levy
R. Phillip Dellinger
Sean R. Townsend
Walter T. Linde-Zwirble
John C. Marshall
Julian Bion
Christa Schorr
Antonio Artigas
Graham Ramsay
Richard Beale
Margaret M. Parker
Herwig Gerlach
Konrad Reinhart
Eliezer Silva
Maurene Harvey
Susan Regan
Derek C. Angus
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 2/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1738-3

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