Marjon Borgert

144 Chapter 6 Ferrer 65 2008, Spain, Sepsis resuscitation/ management bundle Pre/post design Pre intervention: 2 months: Nov- Dec’05 Post interven- tion: 4 month: March-Jun’06 Long term follow up 1yr later on a subset of 23 ICUs: Nov- Dec’06 Multicenter, Medical and surgical ICUs, 59 -hospital mortality -adherence -ICU mortality -28-day mortality -HLOS -ICU LOS Physici- ans and nurses NS AON + Item-by- item/ Overall: 4 months 1) educational program: training physicians and nursing sta in de nitions of severe sepsis and septic shock, their early recognition and the treatment included in the guidelines; 2) posters; 3) pocket cards; 4) audit and feedback 5) the principal investigator acted as local champion; 7) creation of local multidisciplinary teams: they reviewed the pre-intervention performance data and shared ideas about the process impro- vement goals and strategies. Resuscitation bundle: Pre intervention: n=854: n, (%) [CI 95%]: 45 (5.3%), [BI 4-7] p<0.01, Post intervention: 147 (10), [BI 8-12]. Management bundle: pre intervention: n=1465: 93 (10.9), [9-13] Post intervention: 230 (15.7), [14-18]. P <0,001. Castella- nos-Ortega 66 2010, Spain, Sepsis management bundle Quasi exp: pre/post design Pre intervention baseline: 12 months: Jan ‘04- May ‘05. Implementa- tion period: 3 months: June - Aug ‘05. Post intervention: 3 yrs: Sept ‘05- Aug ‘08. Single center, Medical and surgical ICU, 30 beds -in-hospital mortality -LOHS -ICU mortality -compliance Physici- ans and nurses NS AON + Item-by- item/ Overall: 3 years A hospital wide implementation program. 1) educate sta in recognizing severe sepsis and septic shock + intervention included in guide- lines; 2) audit; 3) feedback; 4) posters; 5) pocket cards; 6) lectures; 7) sepsis pro le: optional tool to facilitate an early diagnosis of sepsis and severe sepsis. The management bundle in only implemented within the ICU. 24h-management bundle: Historical group (baseline): n=96: 0 (0), Intervention group: n=384: 5 (1.3%). Lefrant 67 2010, France Sepsis bundle Quality improve- ment: pre/post design 1 Jan - 30 jun’06 (observational period), 1 Jul-31 dec’06 Multicenter, 15 ICUs -28-day mortality -compliance Nurses, physici- ans and residents NS AON + Item-by- item/ Overall: 6 months 1) educational meetings; 2) distribution of edu- cational materials; 3) posters and pocket cards with bundle; 4) video transmission meeting Baseline (observational period): 1/230 (0.5%), Interventional period: 9/215 (4%). Silverman 68 2011, USA, Sepsis bundle NS Pre/post design Phase 1: historic cohort Phase 2: 2006: bundle imple- mentation Phase 3: from Sept’08 bundle plus implemen- tation Single center, Surgical ICU -mortality rate -costs NR NS AON/ Overall: 2 years Phase 2: 1) education of sta ; 2) multidisciplina- ry sepsis team created: one member rounded 2-4 times per week to ensure all appropriate patients were on the bundle. Team developed tools and order sets to facilitate the use of the bundle. Phase 3: addition of an intensivist in 2008: Surgical ICU care team created Phase 2: Bundle group: 19/186 (10%), Phase 3: Bundle plus group: 47.6/68 (70%) Memon 69 2012, Saudi Arabia, Sepsis resuscitation bundle Quasi ex- perimental prospec- tive study Pre intervention: 15 months : Jan ‘08-March 09. Intervention period: 3 month:Apr- Jun’09 Post interven- tion: 24 month: Jul ‘09- Jun ‘11 Medical and surgical ICU, 10 beds -overall comp- liance -30-day mortality -ICU mortality -ICU LOS -LOHS Physi- cians, nurses and res- piratory thera- pists. NS AON/ Overall: 2 years 1) educational lectures; 2) special Task Force Teams; 3) they developed a written protocol to prepare the sepsis bundle for the management of patients with severe sepsis or septic shock Pre intervention (historic group): 5/99 (5.1%) Post intervention: 47/199 (23.6%)