Impact of sepsis bundle strategy on outcomes of patients suffering from severe sepsis and septic shock in china

J Emerg Med. 2013 Apr;44(4):735-41. doi: 10.1016/j.jemermed.2012.07.084. Epub 2013 Jan 16.


Background: It is well known that poor sepsis outcomes are related to delays in diagnosis and treatment.

Objectives: The aim of this study was to compare the mortality rate between two groups of patients, one group presenting before and one group presenting after implementation of the Surviving Sepsis Campaign (SSC) sepsis performance improvement bundles in the Emergency Department (ED).

Methods: This was a prospective study. The studied population included severe sepsis and septic shock patients entered in the SSC database who were admitted to the ED between June 2008 and December 2009. Patients were divided into two groups based on when they presented to the ED. Key treatment interventions, admission to the intensive care unit, and in-hospital mortality were compared. In addition, a survey was completed by the treating physicians to identify reasons for failures to comply with indicators.

Results: One hundred ninety-five (195) patients with severe sepsis and septic shock were enrolled in the study. Mortality was significantly higher at 44.8% in the baseline group (Group 1) compared to 31.6% in the group studied after the SSC protocol was instituted (Group 2) (p < 0.05). Compliance with all elements of the sepsis resuscitation bundle was 1% in Group 1 and 9% in Group 2 (p < 0.05). Compliance with all elements of the management bundle was 1% in Group 1 and 12.8% in Group 2. The most frequently reported reasons by physicians for failure to comply with the bundles were: "did not think it was needed" and "unsure of reason."

Conclusion: The results revealed a significant drop in mortality after implementing the SSC protocol and sepsis performance improvement bundles in the ED. The barriers to implementing sepsis guidelines are knowledge, attitude, and behavioral barriers.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel
  • China / epidemiology
  • Clinical Protocols
  • Female
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Prospective Studies
  • Sepsis / mortality*
  • Sepsis / therapy
  • Shock, Septic / mortality
  • Shock, Septic / therapy