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

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  • dc.contributor.author Ranzani, Otavio
  • dc.contributor.author Barbosa Monteiro, Mariana
  • dc.contributor.author Besen, Bruno Adler Maccagnan Pinheiro
  • dc.contributor.author Azevedo, Luciano Cesar Pontes
  • dc.date.accessioned 2021-04-28T09:25:07Z
  • dc.date.issued 2020
  • dc.description.abstract 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.
  • dc.description.sponsorship Dr. Azevedo is supported by a grant from the National Council for Scientific and Technological Development (CNPq)
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Ranzani OT, Barbosa Monteiro M, Besen BAMP, Azevedo LCP. Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study. Ann Am Thorac Soc. 2020 Aug;17(8):980-987. DOI: 10.1513/AnnalsATS.201910-781OC
  • dc.identifier.doi https://dx.doi.org/10.1513/AnnalsATS.201910-781OC
  • dc.identifier.issn 2329-6933
  • dc.identifier.uri http://hdl.handle.net/10230/47243
  • dc.language.iso eng
  • dc.publisher American Thoracic Society
  • dc.rights Originally 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.201910-781OC
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.subject.other Septicèmia -- Diagnòstic
  • dc.subject.other Septicèmia -- Tractament
  • dc.title Association of sepsis diagnosis at daytime and on weekdays with compliance with the 3-Hour sepsis treatment bundles: a multicenter cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/acceptedVersion

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