Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results

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dc.citation.volume21
dc.contributor.authorMachado, Flavia Ribeiro [UNIFESP]
dc.contributor.authorFerreira, Elaine Maria
dc.contributor.authorSchippers, Pierre|'|de Paula, Ilusca Cardoso
dc.contributor.authorVendrame Saes, Leticia Sandre
dc.contributor.authorde Oliveira, Francisco Ivanildo, Jr.
dc.contributor.authorTuma, Paula
dc.contributor.authorNogueira Filho, Wilson
dc.contributor.authorPiza, Felipe
dc.contributor.authorGuare, Sandra
dc.contributor.authorMangini, Claudia
dc.contributor.authorGuth, Gustavo Ziggiatti
dc.contributor.authorPontes Azevedo, Luciano Cesar [UNIFESP]
dc.contributor.authorResende Freitas, Flavio Geraldo [UNIFESP]
dc.contributor.authorGomes do Amaral, Jose Luiz [UNIFESP]
dc.contributor.authorMansur, Nacime Salomao [UNIFESP]
dc.contributor.authorSalomao, Reinaldo [UNIFESP]
dc.coverageLondon
dc.date.accessioned2020-08-04T13:39:47Z
dc.date.available2020-08-04T13:39:47Z
dc.date.issued2017
dc.description.abstractBackground: Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. Methods: We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality. Afterward, we initiated a multifaceted quality improvement initiative for patients with sepsis or septic shock in all hospital sectors. The primary outcome was hospital mortality over time. The secondary outcomes were the time to sepsis diagnosis and compliance with the entire 6-h bundles throughout the intervention. We defined successful institutions as those where the mortality rates decreased significantly over time, using a logistic regression model. We analyzed differences over time in the secondary outcomes by comparing the successful institutions with the nonsuccessful ones. We assessed the predictors of in-hospital mortality using logistic regression models. All tests were two-sided, and a p value less than 0.05 indicated statistical significance. Results: We included 3435 patients from the emergency departments (50.7%), wards (34.1%), and intensive care units (15.2%) of 9 institutions. Throughout the intervention, there was an overall reduction in the risk of death, in the proportion of septic shock, and the time to sepsis diagnosis, as well as an improvement in compliance with the 6-h bundle. The time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. However, there was a significant reduction in mortality in only two institutions. The reduction in the time to sepsis diagnosis was greater in the successful institutions. By contrast, the nonsuccessful sites had a greater increase in compliance with the 6-h bundle. Conclusions: Quality improvement initiatives reduced sepsis mortality in public Brazilian institutions, although not in all of them. Early recognition seems to be a more relevant factor than compliance with the 6-h bundle.en
dc.description.affiliationUniv Fed Sao Paulo, Anesthesiol Pain & Intens Care Dept, Sao Paulo, SP, Brazil
dc.description.affiliationLatin Amer Sepsis Inst, Sao Paulo, SP, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Latin Amer Sepsis Inst, Rua Napoleao Barros 715 6 Andar, BR-04024002 Sao Paulo, SP, Brazil
dc.description.affiliationSPDM, Sao Paulo, SP, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Infect Dis Dept, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Anesthesiol Pain & Intens Care Dept, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Latin Amer Sepsis Inst, Rua Napoleao Barros 715 6 Andar, BR-04024002 Sao Paulo, SP, Brazil
dc.description.affiliationUnifespSPDM, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Infect Dis Dept, Sao Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipFundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP) (Programa de Pesquisa para Politicas Publicas [PPSUS])
dc.description.sponsorshipIDFAPESP: 2009/53227-7
dc.format.extent-
dc.identifierhttp://dx.doi.org/10.1186/s13054-017-1858-z
dc.identifier.citationCritical Care. London, v. 21, p. -, 2017.
dc.identifier.doi10.1186/s13054-017-1858-z
dc.identifier.fileWOS000414033600001.pdf
dc.identifier.issn1466-609X
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/57126
dc.identifier.wosWOS:000414033600001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofCritical Care
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectSepsisen
dc.subjectBundlesen
dc.subjectSeptic shocken
dc.subjectDeveloping countriesen
dc.titleImplementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous resultsen
dc.typeinfo:eu-repo/semantics/article
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