Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia.

OBJECTIVE

To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.

DESIGN

Prospective cohort study.

SETTING

Eight urban hospitals, five countries in Asia.

PARTICIPANTS

Adult patients with severe sepsis or septic shock.

INTERVENTIONS

Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.

MAIN OUTCOME MEASURES

Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.

METHODS

In the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care.

RESULTS

Five hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables.

CONCLUSIONS

Through education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model.