Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study

Rationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results. Objectives: To evaluate the associati...

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Autores: Ranzani, Otavio, Barbosa Monteiro, Mariana, Besen, Bruno Adler Maccagnan Pinheiro, Azevedo, Luciano Cesar Pontes
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2020
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/47243
Acceso en línea:http://hdl.handle.net/10230/47243
https://dx.doi.org/10.1513/AnnalsATS.201910-781OC
Access Level:acceso abierto
Palabra clave:Septicèmia -- Diagnòstic
Septicèmia -- Tractament
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spelling Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort studyRanzani, OtavioBarbosa Monteiro, MarianaBesen, Bruno Adler Maccagnan PinheiroAzevedo, Luciano Cesar PontesSepticèmia -- DiagnòsticSepticèmia -- TractamentRationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results. Objectives: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus weekends with 3-hour sepsis treatment bundle compliance. Methods: This was an observational, multicenter study including patients with sepsis admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were daytime (7:00 a.m.-6:59 p.m.) versus nighttime (7:00 p.m.-6:59 a.m.) and weekdays (Monday 7:00 a.m.-Friday 6:59 p.m.) versus weekends (Friday 7:00 p.m.-Monday 6:59 a.m.). Our primary outcome was full compliance with the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models. Results: Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (adjOR) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (95% confidence interval [CI], 1.23-1.49; P < 0.001) and was more pronounced in the emergency department (adjOR, 1.55; 95% CI, 1.35-1.77; P < 0.001) than in nonemergency areas (adjOR, 1.19; 95% CI, 1.04-1.37; P = 0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR, 1.08; 95% CI, 0.98-1.19; P = 0.115), although there was an association among those diagnosed in nonemergency areas (adjOR, 1.15; 95% CI, 1.00-1.32; P = 0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident 2 years after implementation of the quality improvement initiative. Conclusions: Compliance with sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.Dr. Azevedo is supported by a grant from the National Council for Scientific and Technological Development (CNPq)American Thoracic Society20212020info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/47243https://dx.doi.org/10.1513/AnnalsATS.201910-781OCreponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésOriginally Published in: Otavio T. Ranzani, Mariana Barbosa Monteiro, Bruno Adler Maccagnan Pinheiro Besen, Luciano Cesar Pontes Azevedo. Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study. Annals of the American Thoracic Society 2020;17:980-987. DOI: 10.1513/AnnalsATS.201910-781OC © 2020 by the American Thoracic Society. The final publication is available at https://dx.doi.org/10.1513/AnnalsATS.201910-781OCinfo:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/472432026-06-12T07:21:37Z
dc.title.none.fl_str_mv Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
title Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
spellingShingle Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
Ranzani, Otavio
Septicèmia -- Diagnòstic
Septicèmia -- Tractament
title_short Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
title_full Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
title_fullStr Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
title_full_unstemmed Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
title_sort Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
dc.creator.none.fl_str_mv Ranzani, Otavio
Barbosa Monteiro, Mariana
Besen, Bruno Adler Maccagnan Pinheiro
Azevedo, Luciano Cesar Pontes
author Ranzani, Otavio
author_facet Ranzani, Otavio
Barbosa Monteiro, Mariana
Besen, Bruno Adler Maccagnan Pinheiro
Azevedo, Luciano Cesar Pontes
author_role author
author2 Barbosa Monteiro, Mariana
Besen, Bruno Adler Maccagnan Pinheiro
Azevedo, Luciano Cesar Pontes
author2_role author
author
author
dc.subject.none.fl_str_mv Septicèmia -- Diagnòstic
Septicèmia -- Tractament
topic Septicèmia -- Diagnòstic
Septicèmia -- Tractament
description Rationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results. Objectives: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus weekends with 3-hour sepsis treatment bundle compliance. Methods: This was an observational, multicenter study including patients with sepsis admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were daytime (7:00 a.m.-6:59 p.m.) versus nighttime (7:00 p.m.-6:59 a.m.) and weekdays (Monday 7:00 a.m.-Friday 6:59 p.m.) versus weekends (Friday 7:00 p.m.-Monday 6:59 a.m.). Our primary outcome was full compliance with the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models. Results: Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (adjOR) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (95% confidence interval [CI], 1.23-1.49; P < 0.001) and was more pronounced in the emergency department (adjOR, 1.55; 95% CI, 1.35-1.77; P < 0.001) than in nonemergency areas (adjOR, 1.19; 95% CI, 1.04-1.37; P = 0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR, 1.08; 95% CI, 0.98-1.19; P = 0.115), although there was an association among those diagnosed in nonemergency areas (adjOR, 1.15; 95% CI, 1.00-1.32; P = 0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident 2 years after implementation of the quality improvement initiative. Conclusions: Compliance with sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.
publishDate 2020
dc.date.none.fl_str_mv 2020
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/47243
https://dx.doi.org/10.1513/AnnalsATS.201910-781OC
url http://hdl.handle.net/10230/47243
https://dx.doi.org/10.1513/AnnalsATS.201910-781OC
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv American Thoracic Society
publisher.none.fl_str_mv American Thoracic Society
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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