The Impact of Clinical Protocols in the Management of Severe Sepsis: A Prospective Cohort Study
Rattachement africain : sg, kr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
This study aimed to assess the availability of clinical protocols and their effect on compliance to the Surviving Sepsis Campaign bundles and on mortality in severe sepsis in ten Singaporean adult teaching intensive care units (ICU). The presence of 11 protocols in the ICUs, steps taken based on the Johns Hopkins University Quality and Safety Research Group's model to translate protocols into practice, and organisational characteristics were assessed. Clinical and research personnel recorded characteristics of patients with severe sepsis who were admitted in July 2009, the achievement of sepsis bundle targets and outcomes. Hospital mortality was 39% for 128 patients. Fewer than half of the ICUs had protocols for early goal-directed therapy, blood cultures, antibiotics, steroids, lung-protective ventilation and weaning. Compliance rates with the resuscitation and management bundles were 18 and 3% respectively. Units with protocols were generally not more likely to achieve associated bundle targets. Steps from the Johns Hopkins model to measure performance, engage teams and sustain and extend interventions were taken in fewer than half of the available protocols. However, on logistic regression analysis, the number of protocols available per ICU was independently and inversely associated with mortality. In conclusion, clinical protocols are infrequently available in Singapore's ICUs and when present do not generally improve compliance to the sepsis bundles. These protocols may, however, be a surrogate marker of the quality of care as they are independently associated with decreased mortality. The use of an integrated and multifaceted approach to translate protocols into practice should be considered.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- The Impact of Clinical Protocols in the Management of Severe Sepsis: A Prospective Cohort Study
- Date Crossref
- 01/07/2012
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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National University Hospital Department of Medicine pays non établi dans la noticeÉtablissement de santé
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Tan Tock Seng Hospital Department of Respiratory and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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Changi General Hospital Department of Respiratory Medicine pays non établi dans la noticeÉtablissement de santé
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Gleneagles Hospital pays non établi dans la noticeÉtablissement de santé
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Khoo Teck Puat Hospital Medical Intensive Care Unit pays non établi dans la noticeÉtablissement de santé
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Singapore General Hospital Department of Respiratory and Critical Care Medicine pays non établi dans la noticeÉtablissement de santé
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National University of Singapore pays non établi dans la noticeUniversité ou école supérieure
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Ulsan College Department of Pulmonary and Critical Care Medicine pays non établi dans la noticeUniversité ou école supérieure
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Asan Medical Center pays non établi dans la noticeÉtablissement de santé
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University of Ulsan pays non établi dans la noticeUniversité ou école supérieure
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Singapore Society of Intensive Care Medicine's National Investigators for Clinical Epidemiology and Research pays non établi dans la noticeÉtablissement de santé
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Yong Loo Lin School of Medicine Biostatistics Unit pays non établi dans la noticeUniversité ou école supérieure
Department of Medicine — National University Hospital, Department of Respiratory and Critical Care Medicine — Tan Tock Seng Hospital et Department of Respiratory Medicine — Changi General Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.