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Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles

Jeffrey J Fong1, Karen Cecere, John Unterborn

  • 1School of Pharmacy, Northeastern University, Boston, MA 02115, USA.

The Annals of Pharmacotherapy
|May 10, 2007
PubMed

Insights

Severe sepsis quality indicator bundles from IHI, JCAHO, and VHA show significant variability in compliance rates and associated patient factors. Developing a unified bundle is crucial for reliable benchmarking and improving sepsis care quality.

Area of Science:

  • Critical Care Medicine
  • Healthcare Quality Improvement
  • Sepsis Management

Background:

  • Multiple quality indicator bundles exist for severe sepsis treatment: Voluntary Hospitals of America (VHA), Institute for Healthcare Improvement (IHI), and Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
  • Suspected differences in quality indicators among these bundles may result in inconsistent benchmarking data.

Purpose of the Study:

  • To compare bundle compliance rates across the IHI, JCAHO, and VHA severe sepsis bundles.
  • To identify patient factors associated with compliance for each bundle.
  • To explore reasons for observed variability in compliance and associated factors.

Main Methods:

  • Retrospective, noninterventional study design.
  • Evaluation of 50 adult severe sepsis patients admitted to a university-affiliated hospital's intensive care unit.
  • Analysis of compliance with quality indicators within the IHI, JCAHO, and VHA bundles.

Main Results:

  • Few patients achieved high compliance (≥75%) with any bundle (IHI 22%, JCAHO 6%, VHA 22%).
  • Significant differences in meeting ≥50% of indicators were observed between JCAHO (28%) and IHI (66%) or VHA (60%).
  • Compliance was associated with shock, higher APACHE II scores, multiple organ failures, and survival, varying by bundle.

Conclusions:

  • Discrepancies among severe sepsis bundles cause variability in compliance and associated patient factors, potentially confusing institutional benchmarking.
  • A single, valid, and reliable bundle is needed to standardize and improve the quality of severe sepsis care.
Abstract

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