223 changing clinical behavior (process compliance with bundle targets and of 0.8% per quarter and 5.4% over improvement) via bundles based on association with hospital mortality. 2 years (95% CI, 2.5–8.4%). Con- key SSC guideline recommendations Compliance with the entire resusci- clusions: The Campaign was on process improvement and patient tation bundle increased linearly from associated with sustained, continuous outcomes. Design and setting: A 10.9% in the ﬁrst site quarter to quality improvement in sepsis care. multifaceted intervention to facilitate 31.3% by the end of 2 years Although not necessarily cause and compliance with selected guideline (P \ 0.0001). Compliance with the effect, a reduction in reported hospital recommendations in the ICU, ED, entire management bundle started at mortality rates was associated with and wards of individual hospitals and 18.4% in the ﬁrst quarter and participation. The implications of this regional hospital networks was increased to 36.1% by the end of study may serve as an impetus for implemented voluntarily in the US, 2 years (P = 0.008). Compliance similar improvement efforts. Europe, and South America. Ele- with all bundle elements increased ments of the guidelines were signiﬁcantly, except for inspiratory Keywords Severe sepsis ‘‘bundled’’ into two sets of targets to plateau pressure, which was high at Septic shock Knowledge transfer be completed within 6 h and within baseline. Unadjusted hospital mortal- Performance measures Surviving 24 h. An analysis was conducted on ity decreased from 37 to 30.8% over sepsis campaign Performance data submitted from January 2005 2 years (P = 0.001). The adjusted improvement Sepsis bundles through March 2008. Main results: odds ratio for mortality improved the Quality improvement Data from 15,022 subjects at 165 sites longer a site was in the Campaign, were analyzed to determine the resulting in an adjusted absolute drop Introduction analysis of the registry data describes the global initiative, its implementation, and reports its impact on process Severe sepsis accounts for 20% of all admissions to improvement and patient outcomes. intensive care units (ICUs) and is the leading cause of death in non-cardiac ICUs, yet comprehensive clinical practice guidelines had not existed [1, 2]. In 2002, hopeful that outcomes of sepsis might be improved by standard- Methods izing care and informed by data from an increasing number of clinical trials [3–10], the European Society of The SSC performance improvement initiative was laun- Intensive Care Medicine (ESICM), the International ched in multiple sites internationally to measure changes Sepsis Forum (ISF), and the Society of Critical Care in the rates at which the sites achieved the targets of the Medicine (SCCM) launched the Surviving Sepsis Cam- guideline bundles and to assess the impact of compliance paign (SSC or ‘‘the Campaign’’) [11]. Evidence-based with the program on hospital mortality. The Campaign guidelines were developed through a formal and trans- activities included: the development of sepsis bundles; parent process [12–14]. The initial guidelines were creation of educational materials; recruitment of sites and published in 2004 (endorsed by 11 professional societies); local physician and nurse champions through national and an updated version was published in 2008 (involving 18 international meetings; organization of regional launch organizations comprising professional societies and meetings where the initiative was introduced and educa- organized networks of hospitals). tional materials presented; and the distribution of a secure The development and publication of guidelines often database application that allowed for data collection and do not lead to changes in clinical behavior and guidelines transfer, and offered a simple means for providing prac- are rarely, if ever, integrated into bedside practice in a tice audit and feedback to local clinicians. timely fashion [15–20]. The most effective means for achieving knowledge transfer remains an unanswered question across all medical disciplines [21, 22]. Recog- Guideline and bundle development nizing that implementing guidelines presents a signiﬁcant challenge, the Campaign set out to develop and evaluate a After the development of the evidence-based guidelines, multifaceted model to change bedside practice to be the SSC steering committee partnered with the Institute consistent with the recently published management for Healthcare Improvement (IHI) to develop a quality guidelines for patients with severe sepsis and septic improvement program to extend the Campaign guidelines shock. A central part of that program was an international to the bedside management of severely septic and septic registry into which providers could recruit and enter shock patients [23, 24]. In partnership with IHI, key patients and monitor their institution’s performance. This elements of the guidelines were identiﬁed and organized