Valiveru Ramya C, Cherian Anusha, Srinivasan Krishnamachari, Maroju Nanda K
Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Cureus. 2021 Jun 27;13(6):e15961. doi: 10.7759/cureus.15961.
Background Sepsis is the predominant cause of morbidity and mortality in patients with peritonitis. "Surviving Sepsis Campaign" (SSC) is an international effort in reducing mortality based on evidence-based guidelines. This study aims to assess the impact of audit-based feedback in a Plan-Do-Study-Act (PDSA) format on improving the implementation of the SSC guidelines in patients with generalized peritonitis at our center. Methods This prospective observational study was conducted in four audit cycles in PDSA format. Multi-departmental inputs were taken to suggest modifications in practice. A questionnaire-based analysis of reasons for non-compliance was performed to find out the opinions and reasons for non-compliance. Morbidity, mortality, and the length of ICU and hospital stay among these patients were also analyzed. Results Baseline compliance with intravenous (IV) bolus administration, central venous pressure (CVP)-guided fluids, and inotropes support when indicated were 100%. Over the course of the three audit cycles, statistically significant improvement in compliance was noted for obtaining blood cultures before antibiotics, antibiotic administration within three hours of presentation, and serum lactate measurement. Overall bundle compliance improved from 9.2% to 64.7% by the end of audit cycle III. Conclusions This study demonstrates that audit-based feedback is a dependable means of improving compliance with SSC guidelines. It brings about improvement by educating users, modifying their behavior through feedback, and enhances process improvement by identifying and correcting systemic deficiencies in the organization.
脓毒症是腹膜炎患者发病和死亡的主要原因。“拯救脓毒症运动”（SSC）是一项基于循证指南降低死亡率的国际行动。本研究旨在评估以计划-实施-研究-改进（PDSA）模式进行的基于审核的反馈对提高我院中心弥漫性腹膜炎患者SSC指南实施情况的影响。方法：本前瞻性观察性研究以PDSA模式分四个审核周期进行。多部门参与提供实践改进建议。通过基于问卷的分析来找出不依从的原因，以了解不依从的意见和原因。还对这些患者的发病率、死亡率以及重症监护病房（ICU）住院时间和住院总时长进行了分析。结果：基线时，静脉推注给药、中心静脉压（CVP）指导下的液体治疗以及在有指征时使用血管活性药物支持的依从率为100%。在三个审核周期中，在使用抗生素前采集血培养、就诊三小时内给予抗生素以及测量血清乳酸方面，依从性有统计学意义的显著改善。到审核周期III结束时，总体集束依从率从9.2%提高到了64.7%。结论：本研究表明，基于审核的反馈是提高SSC指南依从性的可靠方法。它通过教育使用者、通过反馈改变其行为以及通过识别和纠正组织中的系统缺陷来促进流程改进，从而带来改善。
