Association of Sepsis Diagnosis at Daytime and on Weekdays with Compliance to the 3-Hour Sepsis Treatment Bundles: A Multicenter Cohort Study.

Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results.
To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus on weekends with 3-hour sepsis treatment bundles compliance.
Observational, multicenter study including septic patients admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were Daytime (07:00 AM-6:59 PM) versus nighttime (7:00 PM-06:59 AM) and weekdays (Monday 7:00 AM-Friday 06:59 PM) versus weekends (Friday 7:00 PM-Monday 06:59 AM). Our primary outcome was full compliance to the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models.
Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (95% CI) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (1.23-1.49, p<0.001) and was more pronounced in the emergency department (adjOR 1.55, 1.35-1.77, p<0.001) than in non-emergency areas (adjOR 1.19, 1.04-1.37, p=0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR 1.08, 0.98-1.19, p=0.115), although there was an association among those diagnosed in non-emergency areas (adjOR 1.15, 1.00-1.32, p=0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident two years after implementation of the quality improvement initiative.
Compliance to sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.