SEVERE SEPSIS BUNDLES

The changes called for on these pages mirror the individual elements of the Severe Sepsis Bundles.  Taken together, we believe these changes will substantially reduce mortality due to severe sepsis.  The Severe Sepsis Bundles are a distillation of the evidence-based recommendations found in the 2008 practice guidelines promulgated by the Surviving Sepsis Campaign.

Ranking the Evidence

Choosing therapies to treat patients with severe sepsis and septic shock requires an organized approach to evaluating the evidence.  The Sepsis Resuscitation and Management Bundles were derived from the 2008 Surviving Sepsis Campaign Guidelines which incorporated the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system approach to evaluating the literature.
 
Understanding the Bundle Concept

A "bundle" is a group of therapies  for a given  disease that, when implemented together, may result in better outcomes than if implemented individually. In a bundle, the individual elements included are built around best evidence-based practices.  The science supporting the individual treatment strategies in  a bundle is sufficiently mature such that implementation of the approach should be considered either best practice or a reasonable and generally accepted practice.
 
The purpose of creating a bundle strategy is to clearly articulate a therapeutic framework that will function as a lever for change.  We anticipate thatmaking the Severe Sepsis Bundles standard practice will eliminate the piecemeal or chaotically applied of standards for sepsis care that characterize many clinical environments today. 
 
The Severe Sepsis Bundles have been designed with the hope to allow teams to follow the timing, sequence, and goals in the bundles, ito achieve  a 25 percent reduction in mortality due to severe sepsis or septic shock.   
 
We hope hospitals will use the bundles to create customized protocols and pathways that will function well within their institutions.  However, we encourage that each of the elements in the bundles  be incorporated in those protocols.  Optimally, the protocols should closely mirror the bundles, but allow flexibility for logistical and other needs specific to -each hospital.  The reason to include the therapies specified in the bundles in your protocol for care is that if you use our measurement strategies and database, you will be measured as compliant (or non-compliant) with those elements.  Therefore, if not all of the elements of the bundles are incorporated into your customized protocol, your performance on the quality indicators we have designed will suffer.  In addition, we believe the elements to be the best strategy to improve care.
 
There are two Severe Sepsis Bundles.  Each bundle articulates objectives to be accomplished within specific timeframes.  The bundles have been developed based upon the 2008 Surviving Sepsis Campaign Guidelines for the Management of Severe Sepsis and Septic Shock.  The Guidelines incorporated an evidence based review of the literature and ranked the strength of each recommendation.  In the following pages, the grading of the evidence supporting each element is noted and a separate page describes the evidence ranking process.