A multifaceted educational intervention improved anti-infectious measures but had no effect on mortality in patients with severe sepsis
Authors: Schwarzkopf Daniel , Matthaeus-Kraemer Claudia Tanja , Thomas-Rüddel Daniel O. , Rüddel Hendrik , Poidinger Bernhard , Bach Friedhelm , Gerlach Herwig , Gründling Matthias , Lindner Matthias , Scheer Christian , Simon Philipp , Weiss Manfred , Reinhart Konrad , Bloos Frank ,   MEDUSA study group, Marx Gernot , Schindler Achim , Schürholz Tobias , Schlegel‑Höfner Heike , Lehmann Gunther , Sander Annett , Friese Steffen , Scholz Christian , Fischer Pia , Fuchs Christina , Becher Lutz , Salewsky Norbert , Schreiber Torsten , Goldmann Anton , Keh Didier , Schmid Katrin , Menning Winfried , Steuckart Renate , Barz Robert , Dey Karin , Fahrenholz Meike , Müller Martin , Toussaint Susanne , Brederlau Jörg , Buschmann Dirk , Gummelt Ingo , Hoeschen J. , Klaproth Marion , Vedder Ina , Bachmann‑Holdau Ulrike , Eiche Jürgen , Hauschild Rolf , Lange Martina , Herrmann‑Karbaum Davia , Lubasch Annette , Rücker Marcus , Icke Christian , Lucht Alexander , Meier‑Hellmann Andreas , Wagner Jan , Arnold Olaf , Kästner Steffen , Clausen Tobias , Sternkopf Michael , Voswinckel Robert , Benndorf T. , Eiserloh Christel , Kuhnle Gerhard , Koch Mathias , Gerber Manuela , Guderian Liane , Kuhn Sven‑Olaf , Scheiber Gerd , Bloos Frank , D’Aria Stefanie , Lemke Thees , Michaelsen Birgit , Schädler Dirk , Schulz‑Ruhtenberg Nina , Weiler Norbert , Anetseder Martin , Textor Zoran , Kaisers Udo , Löbe Matthias , Meineke Frank , Pausch Christine , Engel Christoph , Braun Georg , Jensen Nicole , Gegenfurtner Werner , Meinhardt Alexander , Schmitt Robert , Teichert Andrea , Becker Klaus‑Dieter , Diers Anja , Jelschen Florian , Weyland Andreas , Knebel Frieder , Kupfer Thomas , Sinz Rüdinger , Bautz Petra , Fischer Annemarie , Seibel Armin , Fleischhacker Christoph , Häberle Helene , Henn Philipp , Mezger Friederike , Rosenberger Peter , Riessen Reimer , Ziegler Silvia , Barth Eberhard , Bracht Hendrik , Heymann I. , Hinder A. , Sens R. , Lascho Christof , Micke Henriette , Schmidt Falk , Schilling Stefanie , Wöbker Gabriele 
Published: March 2022

Sepsis is a major reason for preventable hospital deaths. A cluster-randomized controlled trial on an educational intervention did not show improvements of sepsis management or outcome. We now aimed to test an improved implementation strategy in a second intervention phase in which new intervention hospitals (former controls) received a multifaceted educational intervention, while controls (former intervention hospitals) only received feedback of quality indicators. Changes in outcomes from the first to the second intervention phase were compared between groups using hierarchical generalized linear models controlling for possible confounders. During the two phases, 19 control hospitals included 4050 patients with sepsis and 21 intervention hospitals included 2526 patients. 28-day mortality did not show significant changes between study phases in both groups. The proportion of patients receiving antimicrobial therapy within one hour increased in intervention hospitals, but not in control hospitals. Taking at least two sets of blood cultures increased significantly in both groups. During phase 2, intervention hospitals showed higher proportion of adequate initial antimicrobial therapy and de-escalation within 5 days. A survey among involved clinicians indicated lacking resources for quality improvement. Therefore, quality improvement programs should include all elements of sepsis guidelines and provide hospitals with sufficient resources for quality improvement.

Trial registration: ClinicalTrials.gov, NCT01187134. Registered 23 August 2010, https://www.clinicaltrials.gov/ct2/show/study/NCT01187134.