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BMC Anesthesiology

, 12:28

First Online: 20 November 2012Received: 30 November 2011Accepted: 28 October 2012


BackgroundSigns of serious clinical events overlap with those of sepsis. We hypothesised that any education on severe sepsis-septic shock may affect the outcome of all hospital patients. We designed this study to assess the trend of the mortality rate of adults admitted to hospital for at least one night in relationship with a hospital staff educational program dedicated to severe sepsis-septic shock.

MethodsThis study was performed in six Italian hospitals in the same region. Multidisciplinary Sepsis Teams members were selected by each hospital management among senior staff. The education included the following steps: i the Teams were taught about adult learning, problem based learning, and Surviving Sepsis guidelines, and provided with educational material literature, electronic presentations, scenarios of clinical cases for training and booklets; ii they started delivering courses and seminars each to their own hospital staff in the last quarter of 2007.

To analyse mortality, we selected adult patients, admitted for at least one night to the wards or units present in all the study hospitals and responsible for 80% of hospital deaths. We fitted a Poisson model with monthly hospital mortality rates from December 2003 to August 2009 as dependent variable. The effect of the educational program on hospital mortality was measured as two dummy variables identifying a first November 2007 to December 2008 and a second January to August 2009 education period. The analysis was adjusted for a linear time trend, seasonality and monthly average values of age, Charlson score, length of stay in hospital and urgent-non-urgent admission.

ResultsThe hospital staff educated reached 30.6% at the end of June 2009. In comparison with the pre-education period, the Relative Risk of death of the patient population considered was 0.93 95% confidence interval CI 0.87-0.99; p 0.025 for in-patients in the first, and 0.89 95% CI 0.81-0.98; p 0.012 for those in the second period after education.

ConclusionOur hypothesis that a program educating hospital staff to early detection and treatment of severe sepsis-septic shock may affect the outcome of all hospital patients is original, but it has to be corroborated by other experiences.

AbbreviationsLOSLength of stay

RRRelative risk

SDOScheda di Dimissione Ospedaliera discharge database

SS-SSSevere sepsis and septic shock. Some preliminary data were presented at the 22 Annual Congress of the European Society of Intensive Care Medicine held in Vienna 11–14 Oct 2009 and as an abstract at the congress -Ricerca and innovazione nel servizio sanitario dell’Emilia-Romagna- Bologna, 18–19 Jan 2010.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-12-28 contains supplementary material, which is available to authorized users.

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Autor: Maurizia Capuzzo - Marco Rambaldi - Giovanni Pinelli - Manuela Campesato - Antonia Pigna - Marco Zanello - Maria Barbagallo


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