Miller III et al. (2013) [40]

To assess the effect on mortality of compliance with a severe

sepsis and septic shock management guidelines.

An observational, retrospective, descriptive design was used. The study was conducted over three stages based on ICU admission date: (1) baseline and bundle development stage, (2) implementation stage, and (3) tracking stage.

18 ICUs in 11

hospitals in Utah and Idaho in the USA.

N = 4329

convenient

2004 and 2010

Severe sepsis and septic shock guidelines were associated with a marked reduction in hospital mortality after adjustment for age, severity of illness, and comorbidities. Relative mortality declined 59.0% from 21.2% at baseline to 8.7% for 2010 (p < 0.0001).

Sánchez et al. (2017) [41]

To analyze the evolution of sepsis-related mortality in Spanish ICUs following the introduction of the SSC guidelines and the relationship with sepsis process-of-care.

Quasi-experimental prospective cohort design was used. The study was conducted during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group).

41 medical-surgical ICUs in tertiary hospitals in Spain.

N = 1348

Consecutive

2005 to 2011

Patients in the interventional group had lower hospital mortality (32.6% vs. 44.0%; p < 0.001), lower 28-day mortality (23.0% vs. 36.5%; p < 0.001), and lower adjusted mortality (OR 0.64 [0.49 - 0.83], p = 0.001).

Thompson et al. (2016) [42]

To explore how the level of resuscitation guidelines adherence inhospitals influenced changes in outcomes of patients with sepsis and septic shock.

A quasi-experimental study compared patients with sepsis and septic shock in collaborative hospitals to other groups of patients in noncollaborative hospitals using the Michigan Inpatient Database.

87 Michigan hospitals with ICUs in the USA.

N = 48,110

Convenient

2012-2013

High adherence hospitals had significantly reduced in-hospital mortality between pre- and post-periods (35.0% vs 29.7%; p < 0.001), compared to non-collaborative hospitals. High adherence hospitals had significant reductions in mortality (OR, 0.84; 95% CI, 0.79 - 0.93; p < 0.001).