• Michael P Thompson, Mathew J Reeves, Brittany L Bogan, Bruno DiGiovine, Patricia J Posa, and Sam R Watson.
• 1Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.2Keystone Center for Patient Safety & Quality, Michigan Health & Hospital Association, Okemos, MI.3Divisio... more n of Pulmonary, Critical Care, and Sleep Medicine, Henry Ford Health System, Detroit, MI.4St. Joseph Mercy Hospital, Ann Arbor, MI. less
• Crit. Care Med. 2016 Dec 1; 44 (12): 2123-2130.

ObjectivesTo evaluate the impact of a multi-ICU quality improvement collaborative implementing a protocol-based resuscitation bundle to treat septic shock patients.DesignA difference-in-differences analysis compared patient outcomes in hospitals participating in the Michigan Health & Hospital Association Keystone Sepsis collaborative (n = 37) with noncollaborative hospitals (n = 50) pre- (2010-2011) and postimplementation (2012-2013). Collaborative hospitals were also stratified as high (n = 19) and low (n = 18) adherence based on their overall bundle adherence.SettingEighty-seven Michigan hospitals with ICUs.PatientsWe compared 22,319 septic shock patients in collaborative hospitals compared to 26,055 patients in noncollaborative hospitals using the Michigan Inpatient Database.InterventionsMultidisciplinary ICU teams received informational toolkits, standardized screening tools, and continuous quality improvement, aided by cultural improvement.Measurements And Main ResultsIn-hospital mortality and hospital length of stay significantly improved between pre- and postimplementation periods for both collaborative and noncollaborative hospitals. Comparing collaborative and noncollaborative hospitals, we found no additional reductions in mortality (odds ratio, 0.94; 95% CI, 0.87-1.01; p = 0.106) or length of stay (-0.3 d; 95% CI, -0.7 to 0.1 d; p = 0.174). Compared to noncollaborative hospitals, high adherence hospitals had significant reductions in mortality (odds ratio, 0.84; 95% CI, 0.79-0.93; p < 0.001) and length of stay (-0.7 d; 95% CI, -1.1 to -0.2; p < 0.001), whereas low adherence hospitals did not (odds ratio, 1.07; 95% CI, 0.97-1.19; p = 0.197; 0.2 d; 95% CI, -0.3 to 0.8; p = 0.367).ConclusionsParticipation in the Keystone Sepsis collaborative was unable to improve patient outcomes beyond concurrent trends. High bundle adherence hospitals had significantly greater improvements in outcomes, but further work is needed to understand these findings.

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