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Hospital staff education on severe sepsis/septic shock and hospital mortality: an original hypothesis

Maurizia Capuzzo1*, Marco Rambaldi2, Giovanni Pinelli2, Manuela Campesato3, Antonia Pigna4, Marco Zanello5, Maria Barbagallo6, Massimo Girardis7 and Elena Toschi1

Author Affiliations

1 Azienda Ospedaliero-Universitaria S. Anna of Ferrara, Department of Emergency, University Unit of Anaesthesia and Intensive Care, Via Aldo Moro 8 Cona, Ferrara, 44124, Italy

2 Azienda Unità Sanitaria Locale of Modena, Hospital “Baggiovara”, Unit of Emergency Medicine, Modena, Italy

3 Azienda Ospedaliero-Universitaria of Bologna, Department of Emergency/Urgency, General and Transplant Surgery, Unit of Anaesthesiology and Intensive Care “Professor Faenza”, Bologna, Italy

4 Azienda Ospedaliero-Universitaria of Bologna, Department of Specialized Surgeries and Anaesthesiology, Unit of Anaesthesiology “Professor Di Nino”, Bologna, Italy

5 Istituto di Ricovero e Cura a Carattere Scientifico delle Scienze Neurologiche “Bellaria” of Bologna, Unit of Anaesthesia and Intensive Care, Bologna, Italy

6 Azienda Ospedaliero-Universitaria of Parma, Department of Surgery, Unit 2nd of Anaesthesia, Intensive Care and Pain therapy, Parma, Italy

7 Azienda Ospedaliero-Universitaria of Modena, Department of General and Specialized Surgeries, Unit I of Anaesthesia and Intensive Care, Modena, Italy

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BMC Anesthesiology 2012, 12:28  doi:10.1186/1471-2253-12-28

Published: 20 November 2012



Signs of serious clinical events overlap with those of sepsis. We hypothesised that any education on severe sepsis/septic shock may affect the outcome of all hospital patients. We designed this study to assess the trend of the mortality rate of adults admitted to hospital for at least one night in relationship with a hospital staff educational program dedicated to severe sepsis/septic shock.


This study was performed in six Italian hospitals in the same region. Multidisciplinary Sepsis Teams members were selected by each hospital management among senior staff. The education included the following steps: i) the Teams were taught about adult learning, problem based learning, and Surviving Sepsis guidelines, and provided with educational material (literature, electronic presentations, scenarios of clinical cases for training and booklets); ii) they started delivering courses and seminars each to their own hospital staff in the last quarter of 2007.

To analyse mortality, we selected adult patients, admitted for at least one night to the wards or units present in all the study hospitals and responsible for 80% of hospital deaths. We fitted a Poisson model with monthly hospital mortality rates from December 2003 to August 2009 as dependent variable. The effect of the educational program on hospital mortality was measured as two dummy variables identifying a first (November 2007 to December 2008) and a second (January to August 2009) education period. The analysis was adjusted for a linear time trend, seasonality and monthly average values of age, Charlson score, length of stay in hospital and urgent/non-urgent admission.


The hospital staff educated reached 30.6% at the end of June 2009. In comparison with the pre-education period, the Relative Risk of death of the patient population considered was 0.93 (95% confidence interval [CI] 0.87-0.99; p 0.025) for in-patients in the first, and 0.89 (95% CI 0.81-0.98; p 0.012) for those in the second period after education.


Our hypothesis that a program educating hospital staff to early detection and treatment of severe sepsis/septic shock may affect the outcome of all hospital patients is original, but it has to be corroborated by other experiences.