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The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study
  1. Ron Daniels1,
  2. Tim Nutbeam2,
  3. Georgina McNamara1,
  4. Clare Galvin1
  1. 1Good Hope Hospital, Heart of England NHS Foundation Trust, Sutton Coldfield, UK
  2. 2West Midlands Deanery, Birmingham, UK
  1. Correspondence to Dr Ron Daniels, Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield B75 7RR, UK; sepsisteam{at}


Background Severe sepsis is likely to account for around 37 000 deaths annually in the UK. Five years after the international Surviving Sepsis Campaign (SSC) care bundles were published, care standards in the management of patients with severe sepsis are achieved in fewer than one in seven patients.

Methods This was a prospective observational cohort study across a 500-bed acute general hospital, to assess the delivery and impact of two interventions: the SSC resuscitation bundle and a new intervention designed to facilitate delivery, the sepsis six. Process measures included compliance with the bundle and the sepsis six; the outcome measure was mortality at hospital discharge.

Results Data from 567 patients were suitable for analysis. Compliance with the bundle increased from baseline. 84.6% of those receiving the sepsis six (n=220) achieved the resuscitation bundle compared with only 5.8% of others. Delivery of the interventions had an association with reduced mortality: for the sepsis six (n=220), 20.0% compared with 44.1% (p<0.001); for the resuscitation bundle (n=204), 5.9% compared with 51% (p<0.001). Those receiving the sepsis six were much more likely to receive the full bundle. Those seen by the sepsis team had improved compliance with bundles and reduced mortality.

Conclusions This study supports the SSC resuscitation bundle, and is suggestive of an association with reduced mortality although does not demonstrate causation. It demonstrates that simplified pathways, such as the sepsis six, and education programmes such as survive sepsis can contribute to improving the rate of delivery of these life-saving interventions.

  • Emergency departments
  • infection
  • intensive care
  • nursing
  • wounds

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  • See Commentary, p 459

  • Funding This study was entirely funded by the National Institute for Healthcare Research Research for Patient Benefit programme (NIHR-RfPB grant PB-PG-0706-10167). The funding body approved the study design only.

  • Competing interests RD was chair of the UK Surviving Sepsis Campaign at the time of the study. He has received honoraria and consultancy fees, and been reimbursed by Eli Lilly and Co, the manufacturer of the critical care drug xigris, for attending a number of conferences. The education programme, survive sepsis, received unrestricted educational grants in 2007 from Eli Lilly and from Astra Zeneca, manufacturers of the antibiotic meropenem, Edwards Lifesciences, manufacturer of the vigileo/flotrac cardiac output monitoring system and Vygon UK, manufacturers of central venous catheters. Neither RD nor survive sepsis have received funds during the past 24 months. TN received a single honorarium from Eli Lilly and Co in 2007 for a presentation at a European meeting. GM and CG have no competing interests.

  • Ethics approval Discussion with our Local Research and Ethics Committee and with the National Institute for Healthcare Research (NIHR) concluded that the study fell outside the need for ethical approval, and that since the study aimed to deliver an accepted gold standard of care, informed consent was unnecessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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