Quality Improvement in Infection COntrol and Sepsis Management in MOdel Regions

Study Overview
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Brief Summary
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The German Quality Network Sepsis is an association trying to improve quality of care for patients with sepsis, severe sepsis and septic shock or being in risc thereof. The icosmos trial investigates the impact on the use of routine data, a risk adjustment algorithm and feedback to all hospitals as well as a structured implementation for regular screening for deteriorating patients, and education on in-hospital mortality.

Detailed Description
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All German hospitals provide a set of routine data to federal adminsitration for reimbursement. This dataset includes all ICD-10-Codes (German adaption) as well as all procedure codes. This dataset is pseudonomized and risk adjusted for every individual case and afterwards feedbacked to each participating hospital including all accumulated data from all other hospitals as well as the German Average for sepsis mortalities provided by the German Federal Institute of Statistcs for benchmarkings. Based on this data, the icosmos trial will provide support to all participating hospitals for two major strategies to be implemented An algorithm for structured analysis of low-risk-fatalities as potentially preventable deaths for underlying problems in diagnosis, treatment, etc high-risk-survivors as best practice coding errors for improvement of coding quality a structured sreening program of every patient on every ward in every shift for deterioration and support algorithms including consiliary support and outreach teams as well as structured education The icosmos trial will investigate the effects as well on quality of coding and sepsis incidence as well as on sepsis-related sepsis in-hospital mortality for participating hospitals in comparison to the German Average.

Official Title
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Quality Improvement in Infection COntrol and Sepsis Management in MOdel Regions / Deutsches Qualitaetsbuendnis Sepsis (German Quality Network Sepsis)

Conditions
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Sepsis, Severe Sepsis, Septic Shock

Intervention / Treatment
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* Other: structured case analysis
* Other: strucured screening every patient, every shift


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for hospitals: hospitals willing to participate Inclusion Criteria for patients / patients' data age over 16 coding of sepsis, severe sepsis, septic shock Exclusion Criteria for hospitals: no intensive care unit on site

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: intervention<br>all hospitals participating in the icosmos trial will be supported in implenatation of the two main interventions. | Other: structured case analysis<br>* implementation of a structured analysis of cases coded as sepsis, severe sepsis, or septic shock after risk adjustment for low-risk-fatalities, high-risk-survivors, and coding errors for preventable deaths, best practice, quality improvement and improvement in coding precision.<br>Other: strucured screening every patient, every shift<br>* implementation of a strutured screening and rescue algorithm on regular wards, emergency departements, and intermediate and intensive care units by checking every patient in every shifts for clinical signs of deterioration and apllying a rescue algorithm including consiliary help and/or the help of outreach teams<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| in-hospital mortality | in-hospital mortality of all patients coded with sepsis, severe sepsis and septic shock in absolute numbers and in relation to the German average | 3 years | 
| sepsis codings | developement of coding of sepsis, severe sepsis and septic shock in absolte numbers and in relation to the German Average | 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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quality improvement, routine data, risk adjustment, sepsis, severe sepsis, septic shock, quality of coding