Differences in compliance with Surviving Sepsis Campaign recommendations according to hospital entrance time: day versus night

Critical Care

Teresa Cardoso³  Altamiro Costa-Pereira²  Irene Aragão⁴  Orquídea Ribeiro¹  Mónica Almeida⁵ 

[1] Orquídea Ribeiro, Department of Health Information and Decision Sciences, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;Altamiro Costa-Pereira, Department of Health Information and Decision Sciences, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;Teresa Cardoso, Unidade de Cuidados Intensivos Polivalente - Hospital de Santo António, Oporto Medical Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal;Irene Aragão,Unidade de Cuidados Intensivos Polivalente - Hospital de Santo António, Oporto Medical Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal;Mónica Almeida, Unidade de Cuidados Intensivos Polivalente - Hospital de Santo António, Oporto Medical Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal

关键词: hospital mortality;    compliance rate;    6-hour bundle;    Surviving Sepsis Campaign (SSC);   

Others  :  818162
DOI  :  10.1186/cc12689

 received in 2012-10-01, accepted in 2013-04-23,  发布年份 2013

【 摘 要 】

Introduction

Higher compliance with Surviving Sepsis Campaign (SSC) recommendations has been associated with lower mortality. The authors evaluate differences in compliance with SSC 6-hour bundle according to hospital entrance time (day versus night) and its impact on hospital mortality.

Methods

Prospective cohort study of all patients with community-acquired severe sepsis admitted to the intensive care unit of a large university tertiary care hospital, over 3.5 years with a follow-up until hospital discharge. Time to compliance with each recommendation of the SSC 6-hour bundle was calculated according to hospital entrance period: day (08:30 to 20:30) versus night (20:30 to 08:30). For the same periods, clinical staff composition and the number of patients attending the emergency department (ED) was also recorded.

Results

In this period 300 consecutive patients were included. Compliance rate was (night vs. day): serum lactate measurement 57% vs. 49% (P = 0.171), blood cultures drawn 59% vs. 37% (P < 0.001), antibiotics administration in the first 3 hours 33% vs. 18% (P = 0.003), central venous pressure >8 mmHg 45% vs. 29% (P = 0.021), and central venous oxygen saturation (SvcO₂) >70%, 7% vs. 2% (P = 0.082); fluids were administered in all patients with hypotension in both periods and vasopressors were administered in patients with hypotension not responsive to fluids in 100% vs. 99%. Time to get specific actions done was also different (night vs. day): serum lactate measurement (4.5 vs. 7 h, P = 0.018), blood cultures drawn (4 vs. 8 h, P < 0.001), antibiotic administration (5 vs. 8 h, P < 0.001), central venous pressure (8 vs. 11 h, P = 0.01), and SvcO₂ monitoring (2.5 vs. 11 h, P = 0.222). The composition of the nursing team was the same around the clock; the medical team was reduced at night with a higher proportion of less differentiated doctors. The number of patients attending the Emergency Department was lower overnight. Hospital mortality rate was 34% in patients entering in the night period vs. 40% in those entering during the day (P = 0.281).

Conclusion

Compliance with SSC recommendations was higher at night. A possible explanation might be the increased nurse to patient ratio in that period. Adjustment of the clinical team composition to the patients' demand is needed to increase compliance and improve prognosis.

【 授权许可】

   
2013 Almeida et al.; licensee BioMed Central Ltd.

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