Institutional members access full text with Ovid®

Share this article on:

Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-Year Study

Levy, Mitchell M. MD, FCCM1; Rhodes, Andrew MB BS, MD (Res)2; Phillips, Gary S. MAS3; Townsend, Sean R. MD4; Schorr, Christa A. RN, MSN5; Beale, Richard MB BS6; Osborn, Tiffany MD, MPH7; Lemeshow, Stanley PhD8; Chiche, Jean-Daniel MD9; Artigas, Antonio MD, PhD10; Dellinger, R. Phillip MD, FCCM11

doi: 10.1097/CCM.0000000000000723
Special Article

Purpose: To determine the association between compliance with the Surviving Sepsis Campaign (SSC) performance bundles and mortality.

Design: Compliance with the SSC performance bundles, which are based on the 2004 SSC guidelines, was measured in 29,470 subjects entered into the SSC database from January 1, 2005, through June 30, 2012. Compliance was defined as evidence that all bundle elements were achieved.

Setting: Two hundred eighteen community, academic, and tertiary care hospitals in the United States, South America, and Europe.

Patients: Patients from the emergency department, medical and surgical wards, and ICU who met diagnosis criteria for severe sepsis and septic shock.

Methods: A multifaceted, collaborative change intervention aimed at facilitating adoption of the SSC resuscitation and management bundles was introduced. Compliance with the SSC bundles and associated mortality rate was the primary outcome variable.

Results: Overall lower mortality was observed in high (29.0%) versus low (38.6%) resuscitation bundle compliance sites (p < 0.001) and between high (33.4%) and low (32.3%) management bundle compliance sites (p = 0.039). Hospital mortality rates dropped 0.7% per site for every three months (quarter) of participation (p < 0.001). Hospital and intensive care unit length of stay decreased 4% (95% CI: 1% - 7%; p = 0.012) for every 10% increase in site compliance with the resuscitation bundle.

Conclusions: This analysis demonstrates that increased compliance with sepsis performance bundles was associated with a 25% relative risk reduction in mortality rate. Every 10% increase in compliance and additional quarter of participation in the SSC initiative was associated with a significant decrease in the odds ratio for hospital mortality. These results demonstrate that performance metrics can drive change in clinical behavior, improve quality of care, and may decrease mortality in patients with severe sepsis and septic shock.

Supplemental Digital Content is available in the text.

1Alpert Medical School at Brown University, Rhode Island Hospital, Providence, Rhode Island.

2Adult Critical Care Directorate, St. George’s Healthcare NHS Trust and St George’s University of London, London, United Kingdom.

3The Ohio State University Center for Biostatistics, Columbus, Ohio.

4California Pacific Medical Center, San Francisco, California.

5Cooper Medical School of Rowan University, Camden, New Jersey.

6Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.

7Washington University School of Medicine, St. Louis, Missouri.

8The Ohio State University College of Public Health, Columbus, Ohio.

9Hôpital Cochin, Paris, France.

10Critical Care Center, Sabadell Hospital, Autonomous University of Barcelona, Barcelona, Spain.

11Cooper Medical School of Rowan University, Camden, New Jersey.

This article is being simultaneously published in Critical Care Medicine and Intensive Care Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Levy consulted for the Eli Lilly Advisory Board and Baxter Lifesciences. His institution received grant support from Eli Lilly Co. and Baxter Lifesciences (Surviving Sepsis Campaign [SSC] has not received Industry support since 2006). Dr. Rhodes received support for travel from ESICM (supported Dr. Rhodes’ work for the SSC), served as an Advisory Board for Astellas, is employed by Eli Lilly (SC member for Prowess Shock trial), and lectured for LiDCO and Edwards Lifesciences. Dr. Phillips’ institution received grant support from a National Institutes of Health (NIH) grant and from the Murdoch Children’s Research Institution. His institution received support for participation in review activities from Rhode Island Hospital, LifeSpan Partner. Dr. Townsend served as a board member for the Roundtable on Critical Care, consulted for Sutter Health and Dignity Health, is employed by the California Pacific Medical Center, and received grant support from the Betty and Gordon Moore Foundation. Dr. Schorr consulted for the Society of Critical Care Medicine (SCCM) (Faculty for East and West coast collaboratives). Dr. Beale consulted for Philips Healthcare and received support for travel from the European Society of Intensive Care and the SCCM. His institution served on the board for the Waters Corporation and Nestle Nutrition; he lectured for Nestle Nutrition and Philips Healthcare; and received grant support from Becton Dickinson (Through UK Government Technology Strategy Board Collaborative Grant Programme), Deltex, and Philips Healthcare. Dr. Osborn consulted for the Institute of Healthcare Improvement (sepsis consultant) and received support for travel from the American College of Emergency Physicians (Scientific Assembly 2011, 2012, 2013). Dr. Lemeshows’ institution received support for participation in review activities from Rhode Island Hospital, LifeSpan Partner. His institution received grant support from a NIH grant and the Murdoch Children’s Research Institution. Dr. Chiche served as board member for GE Healthcare and Nestlé and consulted for Astra Zeneca and Orion Pharma. Dr. Artigas served as board member for Ferrer Pharma; consulted for Almirall, Braun, Hill Rom, and Rubió; and lectured for Phillips, Grifols, Astute, and Hill Rom. His institution received grant support from Grifols. Dr. Dellinger received an honorarium through the SCCM for some of the regional collaborative programs and received support for travel (expenses for regional collaborative programs).

Initial funding for the Surviving Sepsis Campaign (2002–2006) was through unrestricted educational grants from Eli Lilly Co., Edwards Lifesciences, Phillips Medical Systems, and the Coalition for Critical Care Excellence (formed by the SCCM). The sponsors had no involvement in the development, data analysis, or manuscript preparation of this study. No additional funding has been received since that time or during the analysis and development of the study and manuscript.

The corresponding author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

For information regarding this article, Email: Mitchell_Levy@brown.edu

© 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins