Department of Emergency Medicine and Department of Medicine, Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA 92354, USA.
Int J Qual Health Care. 2012 Oct;24(5):452-62. doi: 10.1093/intqhc/mzs045. Epub 2012 Aug 16.
To examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.
Prospective cohort study.
Eight urban hospitals, five countries in Asia.
Adult patients with severe sepsis or septic shock.
Implementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.
Quarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.
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.
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.
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.
考察在亚洲多个国家实施脓毒症捆绑包，采用“团队”与“非团队”患者护理模式对其产生的影响。
前瞻性队列研究。
亚洲 5 个国家的 8 所城市医院。
患有严重脓毒症或脓毒性休克的成年患者。
实施过程分为 6 个四分位数：基线期、教育期和 4 个质量改进期。
每季度捆绑包完成率和院内死亡率，分别与捆绑包完成情况和实施模式相关。
在团队模式中，由重症监护医师负责实施捆绑包，在重症监护病房完成。非团队模式则由急诊医师领导，在急诊科完成作为标准护理的一部分。
共纳入 556 例患者。总的院内死亡率为 29.9%，67.1%的患者患有脓毒性休克。在 6 个实施四分位数中，捆绑包的完成率分别为 13.3%、26.9%、37.5%、45.9%、48.8%和 54.5%（P<0.01）。采用团队模式时，从第 1 四分位数的 37.5%基线提高到第 6 四分位数的 88.2%（P<0.01），而非团队模式的捆绑包完成率从 5.2%提高到 39.5%（P<0.01）。接受整个捆绑包治疗的患者院内死亡率更低（24.5%比 32.7%，P=0.04）。捆绑包完成情况与院内死亡率降低呈相关性（比值比 0.67，95%置信区间 0.45-0.99），但在校正混杂因素后，这种生存获益消失。
通过教育和质量改进措施，亚洲国家的脓毒症捆绑包的初始低依从性得到了改善。与非团队模式相比，团队模式在实现捆绑包依从性方面更有效。
