• Sungwon Na, Win Sen Kuan, Malcolm Mahadevan, Chih-Huang Li, Pinak Shrikhande, Sumit Ray, Michael Batech, H Bryant Nguyen, and ATLAS Investigators.
• Department of Emergency Medicine and Department of Medicine, Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA 92354, USA.
• Int J Qual Health Care. 2012 Oct 1;24(5):452-62.

ObjectiveTo examine the impact of implementing sepsis bundle in multiple Asian countries, having 'team' vs. 'non-team' models of patient care.DesignProspective cohort study.SettingEight urban hospitals, five countries in Asia.ParticipantsAdult patients with severe sepsis or septic shock.InterventionsImplementation was divided into six quartiles: Baseline, Education and four Quality Improvement quartiles.Main Outcome MeasuresQuarterly bundle compliance and in-hospital mortality with respect to bundle completion and implementation model.MethodsIn the team model, the implementation was championed by intensivists, where the bundle was completed in the intensive care unit. The non-team model led by emergency physicians completed the bundle in the emergency department as part of standard care.ResultsFive hundred and fifty-six patients were enrolled. The overall in-hospital mortality rate was 29.9%, and 67.1% of the patients had septic shock. Compliance to the bundle was 13.3, 26.9, 37.5, 45.9, 48.8 and 54.5% over the six quartiles of implementation (P < 0.01). With team model, compliance increased from 37.5% baseline to 88.2% in the sixth quartile (P < 0.01), whereas hospitals with a non-team model increased compliance from 5.2 to 39.5% (P < 0.01). Crude in-hospital mortality was better in the patients who received the entire bundle (24.5 vs. 32.7%, P = 0.04). Bundle completion was associated with crude in-hospital mortality reduction (odds ratio 0.67, 95% confidence interval 0.45-0.99), but this survival benefit disappeared after adjustment for confounding variables.ConclusionsThrough education and quality improvement efforts, initially low sepsis bundle compliance was improved in Asia. A team model was more effective in achieving bundle compliance compared with a non-team model.

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