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Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units
North Shore-LIJ Health System (now Northwell Health) launched a strategic partnership with the Institute for Healthcare Improvement to accelerate the pace of sepsis improvement, focusing initially on sepsis recognition and treatment in emergency departments (EDs). The health system reduced overall sepsis mortality by approximately 50 percent in a six-year period and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in 11 acute care hospitals.
Understanding Bundles: An IHI Faculty Conversation
IHI faculty for the Rethinking Critical Care seminar discuss and try to clarify some important and often misunderstood points about implementing care bundles (such as the Ventilator Bundle and the Central Line Bundle).
Severe Sepsis Bundles
The Severe Sepsis Bundles include the Severe Sepsis 3-Hour Rescuscitation Bundle and the 6-Hour Septic Shock Bundle. The Severe Sepsis Bundles have been revised in conjunction with the updated 2012 International Guidelines for Management of Severe Sepsis and Septic Shock.
WIHI: A Partnership to Reduce Deaths from Sepsis
January 24, 2013 | This WIHI explores how North Shore–Long Island Jewish Health System has reduced its sepsis mortality rate significantly, and what others can learn from their progress.
Using Care Bundles to Improve Health Care Quality
This IHI white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles — a small set of evidence-based interventions for a defined patient population and care setting — and reflects on learning over the past decade.
Passport Exclusive: The Sepsis Bundle
In this video, IHI faculty member Dr. Sean Townsend gives an overview of the Sepsis Bundle and how to get started on this work.
Renal effects of norepinephrine used to treat septic shock patients
This study finds that norepinephrine does not have deleterious effects, and may have beneficial effects, on renal function in patients with severe septic shock.
First Steps and Measures to Reduce Sepsis Mortality
University of Rochester/Strong Health (Rochester, New York, USA) implemented the 2004 Surviving Sepsis Campaign clinical practice guidelines, using a previous iteration of the Sepsis Bundle to decrease septic patients’ overall mortality.
IHI Contributing to Bold International Campaign to Dramatically Reduce Mortality from Sepsis
A team of clinicians and quality leaders from IHI is helping to drive forward the work of a remarkable international partnership, dedicated to reducing the global toll of sepsis — a deadly syndrome that kills more people in a year in North America than breast cancer, lung cancer, and colon cancer combined.
Sepsis Care Enters New Era
They are principles key to transforming health care: teamwork and adherence to standards. In a demonstration of exactly these qualities, a worldwide movement, the Surviving Sepsis Campaign, in partnership with the Institute for Healthcare Improvement, is breaking new ground in a battle against an elusive foe.
Sepsis: Putting the Pieces Together
Baptist Memorial Hospital (Memphis, Tennessee, USA) describes their work to reduce mortality from sepsis in their intensive care settings.
Defeating Sepsis: 25 Percent by 2009
The goal of the Surviving Sepsis Campaign is to reduce the risk of dying from sepsis by 25 percent by 2009. Forty-one countries are participating in this international collaborative effort to improve the treatment of sepsis and reduce the high mortality rate associated with the condition.
Early Goal Directed Therapy Reduces Sepsis Complications and Mortality
At PeaceHealth/St. Joseph Hospital (Bellingham, Washington, USA), a partnership between the ICU and the ED, as well as ongoing surveillance and feedback to individual providers, reduced mortality related to severe sepsis and septic shock from 41 to 50 percent in the two months prior to implementation to an average of 17 percent after implementation of the Sepsis Resuscitation and Sepsis Management Bundles.
Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: A systematic review of randomised trials
A systematic review of randomized controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients.
Practice parameters for hemodynamic support of sepsis in adult patients
This article proposes guidelines for hemodynamic support of adult patients with sepsis and concludes that hemodynamic therapies should be titrated to specific and definable endpoints.
The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection
An observational, prospective cohort study to test whether empirical antibiotic treatment that matches the in vitro susceptibility of the pathogen (appropriate treatment) improves survival in patients with bloodstream infections.
The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting
A prospective cohort study that concludes that the administration of inadequate antimicrobial treatment to critically ill patients with bloodstream infections is associated with a greater hospital mortality compared with adequate antimicrobial treatment of bloodstream infections.
Effects of perfusion pressure on tissue perfusion in septic shock
Prospective study of medical and surgical intensive care patients to measure the effects of increasing mean arterial pressure (MAP) on systemic oxygen metabolism and regional tissue perfusion in septic shock.
A trial of goal-oriented hemodynamic therapy in critically ill patients: SvO2 Collaborative Group
An study detailing whether hemodynamic therapy to raise the cardiac index and oxygen delivery to supranormal may improve outcomes in critically ill patients.
Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock
A placebo-controlled, randomized, double-blind trial finding that a seven-day treatment with low doses of hydrocortisone and fludrocortisone significantly reduced the risk of death in patients with septic shock and relative adrenal insufficiency without increasing adverse events.
Glucose control and mortality in critically ill patients
Single-center, prospective, observational study showing that increased insulin administration is positively associated with death in the ICU regardless of the prevailing blood glucose level.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome
A multi-center, randomized controlled trial comparing a low tidal volume ventilation strategy to traditional ventilation strategies.
Efficacy and safety of recombinant human activated protein C for severe sepsis
A randomized, double-blind, placebo-controlled, multicenter trial showing that treatment with drotrecogin alfa activated significantly reduces mortality in patients with severe sepsis and may be associated with an increased risk of bleeding.
Has the mortality of septic shock changed with time
The authors of this article performed a systematic review of literature to test the mortality of septic shock over time.
Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care
Article describing a study to determine the incidence, cost, and outcome of severe sepsis in the United States.