Analysis of a survey of SSC guideline implemented among Chinese intensivists

OBJECTIVE: To survey the implementation of the "surviving sepsis campaign" (SSC) guidelines for the management of severe sepsis and septic shock among Chinese adult intensive care unit (ICU). METHODS: One of the questionnaires included the understanding of the SSC guidelines and the diagnosis of severe sepsis and septic shock. The other one was about SSC 6-hour bundle and 24-hour bundle. A 5-point Likert scale (total understanding, partial understanding, understood, hardly understood, not understood) was used to elicit answers about the degree in perceiving the guidelines. The other 5-point Likert scale (always, often, sometimes, rarely, never) was used to elicit answers about the frequency of use of the guidelines. The answers to 3-point Likert scale were combined when the survey was statistically analyzed. RESULTS: The questionnaires were E-mailed to 50 adult ICUs from June to September in 2007. A total of 224 physicians from 41 adult ICUs participated in answering, with a response rate of 82%. Among all the answers, one was considered not eligible. Altogether there were forty-one ICUs with 512 beds, including 31 general ICUs and 10 specialty ICUs from 14 provinces admitting almost 20,000 patients per year. Eighty point seven percent of intensivists could completely understand the SSC guideline. More intensivists of general ICU could understand the guidelines better than intensivists of specialty ICU [odds ratio (OR)=2.987, 95% confidence interval (CI): 2.241-3.981, P<0.01]. More chiefs of ICU could understand of the guidelines better than common intensivists (OR=1.949, 95%CI: 1.641-2.361, P<0.01). Doctors of different professional levels such as attending doctors vs. residents (OR=7.750, 95% CI: 3.711-16.184, P<0.01), chief vs. residents showed different attitude toward the guidelines(OR=6.455, 95%CI: 3.420-12.181, P<0.01). Chiefs understand guidelines better than attending doctors, more attending doctors understand guidelines than residents. There were 80.0% intensivists always used the guidelines during work. There were only 46.6% intensivists believe central venous pressure, but 85.6% doctors were willing to use it in guiding their work. Intensivists, who could trust nurses to carry out the guideline, outnumbered those who did not (P=0.000). CONCLUSION: Guidelines for severe sepsis and septic shock guidelines was published in SSC Meeting in 2003. Most Chinese intensivists can understand the SSC guidelines and always use it during their clinical practice.