Arquitectura

Intensive Care Med (2010) 36:222–231 DOI 10.1007/s00134-009-1738-3

ORIGINAL

Mitchell M. Levy R. Phillip Dellinger Sean R. Townsend Walter T. Linde-Zwirble John C. Marshall Julian Bion Christa Schorr Antonio Artigas Graham Ramsay Richard Beale Margaret M. Parker Herwig Gerlach Konrad Reinhart Eliezer Silva Maurene Harvey Susan Regan Derek C. Angus
Received: 26 May 2009 Accepted: 27 November2009 Published online: 13 January 2010 Ó Copyright jointly hold by Springer and ESICM 2010 On behalf of the Surviving Sepsis Campaign. This article is being simultaneously published in Intensive Care Medicine and Critical Care Medicine. This article is discussed in the editorial available at: doi:10.1007/s00134-009-1737-4. Electronic supplementary material The online version of this article(doi:10.1007/s00134-009-1738-3) contains supplementary material, which is available to authorized users.

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

S. R. Townsend Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA, USA S. R. Townsend TheInstitute for Healthcare Improvement, Cambridge, MA, USA W. T. Linde-Zwirble ZD Associates LLC, Perkasie, PA, USA J. C. Marshall Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada J. Bion University Department of Anaesthesia and Intensive Care Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK

M. M. Parker Departmentof Medicine, Stony Brook University, Stony Brook, NY, USA H. Gerlach Vivantes-Klinikum Neukoelln, Berlin, Germany K. Reinhart Clinic for Anesthesiology and Intensive Care, Jena, Germany E. Silva Hospital Israelita Albert Einstein, Sao Paolo, Brazil M. Harvey Consultants in Critical Care, Inc., Glenbrook, NV, USA S. Regan Department of Medicine, Harvard Medical School and General Medicine Division,Massachusetts General Hospital, Boston, MA, USA D. C. Angus CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

A. Artigas Critical Care Centre, Sabadell Hospital, M. M. Levy ()) CIBER Enfermedades Respiratorias, Division of Pulmonary, Sleep and Critical Autonomous University of Barcelona, Care Medicine, Brown University School of Barcelona,Spain Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA G. Ramsay e-mail: Mitchell_Levy@brown.edu Mid Essex Hospital Services NHS Trust, London, UK R. P. Dellinger Á C. Schorr Department of Medicine, University R. Beale of Medicine and Dentistry of New Jersey, Guy’s and St. Thomas’ Cooper University Hospital, NHS Foundation Trust, St. Thomas’ Camden, NJ, USA Hospital, London,UK

Abstract Objective: The Surviving Sepsis Campaign (SSC or ‘‘the Campaign’’) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted

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changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. Design and setting: A multifacetedintervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were ‘‘bundled’’ into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005through March 2008. Main results: Data from 15,022 subjects at 165 sites were analyzed to determine the

compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P \ 0.0001). Compliance with the entire management bundle started at 18.4% in the first...