228 Table 3 Change in achievement of bundle targets Initial care bundle (ﬁrst 6 h of presentation) Measure lactate 61.0 Blood cultures before antibiotics 64.5 Broad spectrum antibiotics 60.4 Fluids and vasopressors 59.8 CVP [8 mmHg 26.3 ScvO2 [70% 13.3 All resuscitation measures 10.9 Management bundle (ﬁrst 24 h after presentation) Steroid policy 58.5 Administration of drotrecogin alfa policy 47.4 Glucose control 51.4 Plateau pressure control 80.8 All management measures 18.4 a Represents the last quarter of data submission from each institution during the 2-year data analysis period, regardless of total number of quarters of each institution’s participation Initial quarter achieved (%) Final quarter achieved (%)a 78.7 78.3 67.9 77.0 38.0 24.3 21.5 73.9 53.5 56.8 83.8 25.5 P value compared to initial B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 0.02 B0.0001 0.09 B0.0001 P value B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 0.0006 eligible subjects at each site. Sites with varying lengths of participation are included in the analysis. While the rate of enrollment over time was relatively constant for each site, the possibility that the types of patients selected changed over time cannot be excluded. We believe the data are encouraging and supportive of the Campaign’s creating beneﬁcial effects both on patient care and patient outcome. Because the bundles combine physiologic end- points and processes of care, measures of compliance may not be precise. However, the improvement in measures over time probably reﬂects improving compliance, Fig. 2 Compliance and mortality change over time: a change in the assuming the case mix was reasonably stable. The inde- percentage of patients compliant with all elements of the resusci- pendent association of these bundle targets with outcome tation bundle (dotted line) and the management bundle (solid line) does not necessarily imply a causal relationship between over 2 years of data collection (*P \ 0.01 compared to ﬁrst the bundle care recommendation and outcomes. Failure to quarter). Note that both Y axes are truncated at 40% to emphasize achieve a target may be indicative of greater severity, so relative change over time as opposed to absolute change; b change in hospital mortality over time (*P \ 0.01 compared to ﬁrst compliance with the attempt alone may produce the false quarter) impression that compliance is associated with reduced P value compared to initial B0.0001 B0.0001 0.0002 B0.0001 B0.0001 B0.0001 B0.0001 B0.0001 0.003 0.0009 0.24 B0.0001 Remaining quarters achieved (%) 72.5 76.3 67.0 71.1 33.9 21.7 21.1 66.8 49.9 55.4 82.6 23.3 Table 4 Multivariable mortality prediction model Variable Admission source Ward compared to ED ICU compared to ED Pneumonia as source of sepsis compared to other infections Organ dysfunction at presentation Cardiovascular Respiratory Hematologic Hepatic Renal Site duration in campaign Per quarter OR 1.87 2.25 1.37 1.39 1.23 1.61 1.28 1.40 0.97 95% CI [1.73, 2.02] [2.02, 2.51] [1.27, 1.48] [1.26, 1.55] [1.14, 1.34] [1.48, 1.75] [1.14, 1.75] [1.30, 1.51] [0.96, 0.99] Model ﬁt statistics: C = 18.1 with 18 df, P = 0.34, log-likelihood R2 sq 36.6%, a v2 dispersion of 1.04