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The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study
Ron Daniels1, Tim Nutbeam, Georgina McNamara
1Good Hope Hospital, Heart of England NHS Foundation Trust, Sutton Coldfield B75 7RR, UK. sepsisteam@googlemail.com
Insights
Implementing the sepsis six pathway and Surviving Sepsis Campaign (SSC) bundles significantly reduced severe sepsis mortality. These interventions improve compliance and patient outcomes in acute care settings.
Area of Science:
- Critical Care Medicine
- Hospital Management
- Patient Safety
Background:
- Severe sepsis causes approximately 37,000 annual deaths in the UK.
- Despite Surviving Sepsis Campaign (SSC) bundles, adherence remains low, affecting less than 15% of patients.
- There is a critical need to improve sepsis management standards.
Purpose of the Study:
- To assess the delivery and impact of the SSC resuscitation bundle and the sepsis six intervention.
- To evaluate the effect of these interventions on compliance and mortality rates.
- To identify facilitators for improving the implementation of sepsis care bundles.
Main Methods:
- A prospective observational cohort study was conducted in a 500-bed acute general hospital.
- Data were collected from 567 patients diagnosed with severe sepsis.
- Process measures included compliance with the SSC resuscitation bundle and the sepsis six; the primary outcome was in-hospital mortality.
Main Results:
- Compliance with the SSC resuscitation bundle increased following the interventions.
- Patients receiving the sepsis six intervention had significantly higher compliance with the resuscitation bundle (84.6% vs 5.8%).
- Both the sepsis six and the resuscitation bundle were associated with reduced mortality (20.0% vs 44.1% and 5.9% vs 51%, respectively).
Conclusions:
- The study supports the SSC resuscitation bundle, showing an association with reduced mortality.
- Simplified care pathways like the sepsis six can improve the delivery of life-saving interventions.
- Educational programs and streamlined protocols are effective in enhancing sepsis management and patient survival.
Background:
Severe sepsis is likely to account for around 37,000 deaths annually in the UK. Five years after the international Surviving Sepsis Campaign (SSC) care bundles were published, care standards in the management of patients with severe sepsis are achieved in fewer than one in seven patients.
Methods:
This was a prospective observational cohort study across a 500-bed acute general hospital, to assess the delivery and impact of two interventions: the SSC resuscitation bundle and a new intervention designed to facilitate delivery, the sepsis six. Process measures included compliance with the bundle and the sepsis six; the outcome measure was mortality at hospital discharge.
Results:
Data from 567 patients were suitable for analysis. Compliance with the bundle increased from baseline. 84.6% of those receiving the sepsis six (n = 220) achieved the resuscitation bundle compared with only 5.8% of others. Delivery of the interventions had an association with reduced mortality: for the sepsis six (n = 220), 20.0% compared with 44.1% (p < 0.001); for the resuscitation bundle (n = 204), 5.9% compared with 51% (p < 0.001). Those receiving the sepsis six were much more likely to receive the full bundle. Those seen by the sepsis team had improved compliance with bundles and reduced mortality.
Conclusions:
This study supports the SSC resuscitation bundle, and is suggestive of an association with reduced mortality although does not demonstrate causation. It demonstrates that simplified pathways, such as the sepsis six, and education programmes such as survive sepsis can contribute to improving the rate of delivery of these life-saving interventions.
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