ArticleIntensive care medicine2014
Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study.
Article in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
58 citing papers in PubMed, 3 syntheses or guidelines pooled it, 131 citations in OpenAlex.
- Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice.American journal of respiratory and critical care medicine · 2019Pooled it
- Role of qSOFA in predicting mortality of pneumonia: A systematic review and meta-analysis.Medicine · 2018Pooled it
- Pooled it
- Effectiveness and Safety of an Emergency Department Code Sepsis Protocol: A Pragmatic Clinical Trial.Annals of the American Thoracic Society · 2024Trial
- The German Quality Network Sepsis: study protocol for the evaluation of a quality collaborative on decreasing sepsis-related mortality in a quasi-experimental difference-in-differences design.Implementation science : IS · 2018Trial
- Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial.Intensive care medicine · 2017Trial
- Article
- Prognostic factors in Sézary syndrome - a retrospective propensity score-matched study on 1277 patients.Frontiers in immunology · 2026Article
- Temporal trends and social determinants of sepsis knowledge in Brazil: findings from three national cross-sectional surveys.Annals of intensive care · 2026Article
- Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009-2018.Open forum infectious diseases · 2026Article
- Time to administer polymyxin B hemoperfusion and hemodynamics in patients with septic shock requiring high-dose norepinephrine: a predetermined analysis of a prospective cohort study.Critical care (London, England) · 2025Article
- Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey.American journal of respiratory and critical care medicine · 2025Article
- Improving the outcomes of sepsis in Brazil: strategies and initiatives.Critical care science · 2025Article
- Article
- Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research.Critical care science · 2024Review
- Approach to Intensive Care Costing and Provision of Cost-effective Care.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda.BMC health services research · 2023Article
- Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience.Scientific reports · 2022Article
- Sepsis Management in Southeast Asia: A Review and Clinical Experience.Journal of clinical medicine · 2022Review
- The cost-effectiveness of early goal-directed therapy: an economic evaluation alongside the ARISE trial.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2021Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate whether a multifaceted, centrally coordinated quality improvement program in a network of hospitals can increase compliance with the resuscitation bundle and improve clinical and economic outcomes in an emerging country setting.
methodsThis was a pre- and post-intervention study in ten private hospitals (1,650 beds) in Brazil (from May 2010 to January 2012), enrolling 2,120 patients with severe sepsis or septic shock. The program used a multifaceted approach: screening strategies, multidisciplinary educational sessions, case management, and continuous performance assessment. The network administration and an external consultant provided performance feedback and benchmarking within the network. The primary outcome was compliance with the resuscitation bundle. The secondary outcomes were hospital mortality, hospital and ICU length of stay, quality-adjusted life year (QALY) gain, and cost-effectiveness.
resultsThe proportion of patients who received all the required items for the resuscitation bundle improved from 13% [95% confidence interval (CI) 8-18%] at baseline to 62% (95% CI 54-69%) in the last trimester (p < 0.001). Hospital mortality decreased from 55% (95% CI 48-62%) to 26% (95% CI 19-32%, p < 0.001). Full compliance with the resuscitation bundle was associated with lower risk of hospital mortality (propensity weighted corrected risk ratio 0.74; 95% CI 0.56-0.94, p = 0.02). There was a reduction in the total cost per patient from 29.3 (95% CI 23.9-35.4) to 17.5 (95% CI 14.3-21.1) thousand US dollars from baseline to the last 3 months (mean difference -11,815; 95% CI -18,604 to -5,338). The mean QALY increased from 2.63 (95% CI 2.15-3.14) to 4.06 (95% CI 3.58-4.57). For each QALY, the full compliance saves US$5,383.
conclusionsA multifaceted approach to severe sepsis and septic shock patients in an emerging country setting led to high compliance with the resuscitation bundle. The intervention was cost-effective and associated with a reduction in mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.