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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results

Authors: Flavia Ribeiro Machado, Elaine Maria Ferreira, Pierre Schippers, Ilusca Cardoso de Paula, Letícia Sandre Vendrame Saes, Francisco Ivanildo de Oliveira Jr, Paula Tuma, Wilson Nogueira Filho, Felipe Piza, Sandra Guare, Cláudia Mangini, Gustavo Ziggiatti Guth, Luciano Cesar Pontes Azevedo, Flavio Geraldo Resende Freitas, Jose Luiz Gomes do Amaral, Nacime Salomão Mansur, Reinaldo Salomão, on behalf of the SPDM against sepsis project

Published in: Critical Care | Issue 1/2017

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Abstract

Background

Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality.

Methods

We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality. Afterward, we initiated a multifaceted quality improvement initiative for patients with sepsis or septic shock in all hospital sectors. The primary outcome was hospital mortality over time. The secondary outcomes were the time to sepsis diagnosis and compliance with the entire 6-h bundles throughout the intervention. We defined successful institutions as those where the mortality rates decreased significantly over time, using a logistic regression model. We analyzed differences over time in the secondary outcomes by comparing the successful institutions with the nonsuccessful ones. We assessed the predictors of in-hospital mortality using logistic regression models. All tests were two-sided, and a p value less than 0.05 indicated statistical significance.

Results

We included 3435 patients from the emergency departments (50.7%), wards (34.1%), and intensive care units (15.2%) of 9 institutions. Throughout the intervention, there was an overall reduction in the risk of death, in the proportion of septic shock, and the time to sepsis diagnosis, as well as an improvement in compliance with the 6-h bundle. The time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. However, there was a significant reduction in mortality in only two institutions. The reduction in the time to sepsis diagnosis was greater in the successful institutions. By contrast, the nonsuccessful sites had a greater increase in compliance with the 6-h bundle.

Conclusions

Quality improvement initiatives reduced sepsis mortality in public Brazilian institutions, although not in all of them. Early recognition seems to be a more relevant factor than compliance with the 6-h bundle.
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Metadata
Title
Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results
Authors
Flavia Ribeiro Machado
Elaine Maria Ferreira
Pierre Schippers
Ilusca Cardoso de Paula
Letícia Sandre Vendrame Saes
Francisco Ivanildo de Oliveira Jr
Paula Tuma
Wilson Nogueira Filho
Felipe Piza
Sandra Guare
Cláudia Mangini
Gustavo Ziggiatti Guth
Luciano Cesar Pontes Azevedo
Flavio Geraldo Resende Freitas
Jose Luiz Gomes do Amaral
Nacime Salomão Mansur
Reinaldo Salomão
on behalf of the SPDM against sepsis project
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1858-z

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