QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fong, J. J Articles by Devlin, J. W Search for Related Content PubMed PubMed Citation Articles by Fong, J. J Articles by Devlin, J. W

CRITICAL CARE

Factors Influencing Variability in Compliance Rates and Clinical Outcomes Among Three Different Severe Sepsis Bundles

Critical Care Pharmacy Fellow, School of Pharmacy, Northeastern University, Boston, MA

Karen Cecere, PharmD

Pharmacy Resident, Department of Pharmacy, Tufts–New England Medical Center, Boston

John Unterborn, MD

Staff Physician, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts–New England Medical Center

Erik Garpestad, MD

Staff Physician, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts–New England Medical Center

Mark Klee, PharmD

Clinical Pharmacist Specialist, Department of Pharmacy, Tufts–New England Medical Center

John W Devlin, PharmD BCPS FCCM FCCP

Associate Professor, School of Pharmacy, Northeastern University

Reprints: Dr. Devlin, Northeastern University School of Pharmacy, Mugar #206, 360 Huntington Ave., Boston, MA 02115, fax 617/373-7655, j.devlin{at}neu.edu

BACKGROUND: While 3 different quality indicator bundles are either approved (Voluntary Hospitals of America [VHA], Institute for Healthcare Improvement [IHI]) or proposed (Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) to rate clinical practices in treatment of severe sepsis, it is suspected that differences in the quality indicators among these bundles may lead to discrepant benchmarking data.

OBJECTIVE: To compare bundle compliance and patient factors associated with it among the IHI, JCAHO, and VHA severe sepsis bundles and explore possible reasons for any observed variability.

METHODS: Using a retrospective, noninterventional design, we evaluated 50 adults (APACHE II score 25 ± 6, organ failure 2 ± 1, and shock 52%) with severe sepsis who were admitted consecutively to an intensive care unit at a 450 bed university-affiliated hospital.

RESULTS: Few patients met 100% (IHI 6%, JCAHO 0%, VHA 6%) or 75% or greater (IHI 22%, JCAHO 6%, VHA 22%) of the quality indicators in each bundle. The number of patients who met 50% or more of the quality indicators varied significantly between JCAHO (28%) and both IHI (66%; p < 0.001) and VHA (60%; p < 0.001), but not between IHI and VHA (p = 0.53). Compliance with 50% or more of the quality indicators was more likely to occur when patients had shock (IHI, JCAHO, VHA), an APACHE II score greater than or equal to 25 (VHA), 2 or more organ failures (VHA), or survived hospitalization (IHI). We identified a number of factors that may help explain these differences.

CONCLUSIONS: Differences among the IHI, JCAHO, and VHA severe sepsis bundles lead to variability in bundle compliance rates and the patient factors associated with the variability and may lead to confusion when benchmarking practices among institutions. Future efforts should focus on developing a single valid and reliable bundle that allows providers to improve the quality of sepsis care.

Key Words: quality indicators, septic shock, severe sepsis

Published Online, May 8, 2007. www.theannals.com, DOI 10.1345/aph.1K041