TY - JOUR
T1 - Septic shock
T2 - A multidisciplinary response team and weekly feedback to clinicians improve the process of care and mortality
AU - Schramm, Garrett E.
AU - Kashyap, Rahul
AU - Mullon, John J.
AU - Gajic, Ognjen
AU - Afessa, Bekele
N1 - Funding Information:
Supported, in part, by the National Center for Research Resources, National Institutes of Health (grant 1 UL 1RR024150-01*) , and the National Institutes of Health Roadmap for Medical Research. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health.
PY - 2011/2
Y1 - 2011/2
N2 - Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock. Design: Prospective, interventional cohort study. Setting: The medical intensive care unit of a tertiary, academic medical center. Study Subjects: Patients with severe sepsis or septic shock consecutively treated in a medical intensive care unit. Interventions: Daily auditing and weekly feedback, and sepsis response team activation. Measurements and Main Results: During a 33-month study period, from January 2007 through September 2009, we performed daily screening of patients for severe sepsis or septic shock. Study periods were divided into baseline (screening only), daily auditing with weekly feedback, and sepsis response team activation. Comparisons among the three periods were made by using univariate and multiple logistic regression analyses. Compliance with the overall sepsis resuscitation bundle and its individual elements and hospital mortality were used as outcome measures. A total of 984 episodes of severe sepsis and septic shock were identified during the study periods, severe sepsis in 52 (5.3%) and septic shock in 932 (94.7%). The compliance rate with all elements of the sepsis resuscitation bundle increased from 12.7% at baseline to 37.7% and 53.7% during the weekly feedback and sepsis response team activation periods, respectively (p < .001). Overall hospital mortality rate was 30.3%, 28.3%, and 22.0% during baseline, weekly feedback, and sepsis response team periods, respectively (p = .029). Multiple logistic regression analysis showed that the sepsis response team was associated with reduced risk of hospital death (odds ratio, 0.657; 95% confidence interval, 0.456-0.945; p = .023) whereas hepatic cirrhosis, hepatic failure, leukemia, multiple myeloma, transfer from the same hospital ward, do-not-resuscitate status at the recognition of severe sepsis/septic shock, and lactate level were associated with increased risk of death. Conclusions: In septic shock, the activation of the sepsis response team in combination with weekly feedback increases the compliance with the process of care and reduces hospital mortality rate.
AB - Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock. Design: Prospective, interventional cohort study. Setting: The medical intensive care unit of a tertiary, academic medical center. Study Subjects: Patients with severe sepsis or septic shock consecutively treated in a medical intensive care unit. Interventions: Daily auditing and weekly feedback, and sepsis response team activation. Measurements and Main Results: During a 33-month study period, from January 2007 through September 2009, we performed daily screening of patients for severe sepsis or septic shock. Study periods were divided into baseline (screening only), daily auditing with weekly feedback, and sepsis response team activation. Comparisons among the three periods were made by using univariate and multiple logistic regression analyses. Compliance with the overall sepsis resuscitation bundle and its individual elements and hospital mortality were used as outcome measures. A total of 984 episodes of severe sepsis and septic shock were identified during the study periods, severe sepsis in 52 (5.3%) and septic shock in 932 (94.7%). The compliance rate with all elements of the sepsis resuscitation bundle increased from 12.7% at baseline to 37.7% and 53.7% during the weekly feedback and sepsis response team activation periods, respectively (p < .001). Overall hospital mortality rate was 30.3%, 28.3%, and 22.0% during baseline, weekly feedback, and sepsis response team periods, respectively (p = .029). Multiple logistic regression analysis showed that the sepsis response team was associated with reduced risk of hospital death (odds ratio, 0.657; 95% confidence interval, 0.456-0.945; p = .023) whereas hepatic cirrhosis, hepatic failure, leukemia, multiple myeloma, transfer from the same hospital ward, do-not-resuscitate status at the recognition of severe sepsis/septic shock, and lactate level were associated with increased risk of death. Conclusions: In septic shock, the activation of the sepsis response team in combination with weekly feedback increases the compliance with the process of care and reduces hospital mortality rate.
KW - clinical protocols
KW - critical care
KW - mortality
KW - process assessment (health care)
KW - sepsis
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U2 - 10.1097/CCM.0b013e3181ffde08
DO - 10.1097/CCM.0b013e3181ffde08
M3 - Article
C2 - 21057312
AN - SCOPUS:79251577926
SN - 0090-3493
VL - 39
SP - 252
EP - 258
JO - Critical care medicine
JF - Critical care medicine
IS - 2
ER -