Journal of Emergencies, Trauma, and Shock
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Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 3-9

Compliance with 6 h-Sepsis Resuscitation Bundle of Surviving Sepsis Campaign before and after Resident Physicians' Training: A Quality Improvement Interventional Study among Indian Patients

1 Department of Medicine, AIIMS, New Delhi, India
2 Department of Emergency Medicine, AIIMS, New Delhi, India
3 Department of Biostatistics, AIIMS, New Delhi, India

Correspondence Address:
Dr. Naveet Wig
Department of Medicine, AIIMS, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JETS.JETS_26_18

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Background: Surviving sepsis campaign (SSC) recommends 6 h-sepsis resuscitation bundle for severe sepsis (now termed “sepsis” after the Sepsis-3 definition) or septic shock. The study was done to assess the guideline compliance in Indian patients before and after the resident physicians' training and their impact on the survival. Subjects and Methods: Prospective interventional study (time series design) was conducted. Resident physicians, who were regularly managing the patients of severe sepsis/septic shock, were trained by providing the education and feedback on the guideline compliance at 6-month intervals for three quality improvement (QI) phases. Case details of preintervention and QI phases' patients were reviewed as per the quality indicators, defined by SSC guideline, and compared. Results: The baseline compliance of composite six components of 6 h-sepsis resuscitation bundle was low and significantly increased on postintervention (baseline 0% to 18% at QI 3 (P for trend = 0.01). The compliance of individual components was improved too: serum lactate measurement (26%, P = 0.002), obtaining blood culture (28%, P = 0.003), antibiotic administration (2%, P = 0.56), provision of fluid bolus (60%, P = 0.02), attainment of target central venous pressure (50%, P = 0.03), and optimization of central venous oxygen saturation (20%, P = 0.21). The hospital mortality showed a decreasing trend (18%, P = 0.06). Patients compliant to composite bundle got the mortality benefit (odds ratios = 0.25, 95% [confidence interval, 0.07–0.9]). The study, however, did not show any benefits of mean hospital/Intensive Care Unit (ICU) length of stay. Conclusions: The study establishes lack of acceptance to the prevailing guideline; however, it has shown a significant improvement in adaptation and mortality benefit without reducing mean hospital/ICU length of stay after physicians' repeated educational programs. The barriers to implementation of the prevalent guideline should be searched out in further trials.

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