Adherence to Early Resuscitation Bundle for Severe Sepsis; a multi-hospital system review

Patients aged 65 years and older represent two-thirds of all sepsis discharges in the US (CDC).  With overall sepsis incidence increasing and mortality rates averaging 30%, the Institute for Healthcare Improvement (IHI) and the Surviving Sepsis Campaign have jointly promoted compliance with severe sepsis bundles to reduce mortality.

A multi-hospital health system prioritized severe sepsis mortality reduction as a performance improvement initiative.  Toward this goal, a multidisciplinary task force was established and a database for collection of process and outcome measures was designed and implemented.  Slight modifications to lactate and fluid bundle elements were specified by the task force.  The database provided for uniform variable collection across eleven hospitals and enabled retrospective review and analysis.  Educational efforts to promote collaboration were conducted regarding early recognition and interventions among clinical and ancillary staff involved in the care of sepsis patients.

All-or-none bundle compliance was calculated for severe sepsis patients (N= 8,059) aged 65 and older who were discharged during two years (2012-2013).  A test of two-proportions compared the primary endpoint, in-hospital mortality, by bundle compliance.  Logistic regression was employed to attain adjusted odds ratios for overall and individual element bundle compliance.  Differences in length of stay (LOS) for compliant versus non-compliant groups were tested with an independent t-test.

Compliance with the severe sepsis bundle was associated with a 3.4% (95% CI=1.1%, 5.7%) reduction of in-hospital mortality which supports previous research findings on efficacy of early resuscitation.  Bundle compliance was also associated with a LOS reduction of 1.2 days (95% CI=0.6, 1.9).