Quality Improvement Initiatives in Sepsis in an Emerging Country: Does the Institution's Main Source of Income Influence the Results? An Analysis of 21,103 Patients

被引：18

作者：

Machado, Flavia R. ^{[1
]}

Ferreira, Elaine M. ^{[1
]}

Sousa, Juliana Lubarino ^{[1
]}

Silva, Carla ^{[1
]}

Schippers, Pierre ^{[1
]}

Pereira, Adriano ^{[1
]}

Cardoso, Ilusca M. ^{[1
]}

Salomao, Reinaldo ^{[1
]}

Japiassu, Andre ^{[1
]}

Akamine, Nelson ^{[1
]}

Mazza, Bruno F. ^{[1
]}

Assuncao, Murillo S. C. ^{[1
]}

Fernandes, Haggeas S. ^{[1
]}

Bossa, Aline ^{[1
]}

Monteiro, Mariana B. ^{[1
]}

Caixeita, Noemi ^{[1
]}

Azevedo, Luciano C. P. ^{[1
]}

Silva, Eliezer ^{[1
]}

机构：

[1] Latin Amer Sepsis Inst, Sao Paulo, Brazil

来源：

CRITICAL CARE MEDICINE | 2017年 / 45卷 / 10期

关键词：

mortality; sepsis bundles; sepsis; septic shock; quality improvement; INTENSIVE-CARE UNITS; SURVIVING SEPSIS; CRITICALLY-ILL; SEPTIC SHOCK; OUTCOMES; IMPLEMENTATION; IMPACT; BUNDLES; EPIDEMIOLOGY; MANAGEMENT;

D O I：

10.1097/CCM.0000000000002585

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: We aimed to assess the results of a quality improvement initiative in sepsis in an emerging setting and to analyze it according to the institutions' main source of income (public or private). Design: Retrospective analysis of the Latin American Sepsis Institute database from 2005 to 2014. Settings: Brazilian public and private institutions. Patients: Patients with sepsis admitted in the participant institutions. Interventions: The quality improvement initiative was based on a multifaceted intervention. The institutions were instructed to collect data on 6-hour bundle compliance and outcomes in patients with sepsis in all hospital settings. Outcomes and compliance was measured for eight periods of 6 months each, starting at the time of the enrollment in the intervention. The primary outcomes were hospital mortality and compliance with 6-hour bundle. Measurements and Main Results: We included 21,103 patients; 9,032 from public institutions and 12,071 from private institutions. Comparing the first period with the eigth period, compliance with the 6-hour bundle increased from 13.5% to 58.2% in the private institutions (p < 0.0001) and from 7.4% to 15.7% in the public institutions (p < 0.0001). Mortality rates significantly decreased throughout the program in private institutions, from 47.6% to 27.2% in the eighth period (adjusted odds ratio, 0.45; 95% CI, 0.32-0.64). However, in the public hospitals, mortality diminished significantly only in the first two periods. Conclusion: This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.

引用

页码：1650 / 1659

页数：10

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[1] Critical Care 1 Critical care and the global burden of critical illness in adults [J].