Raise the Flag II: sepsis mortality before and after the introduction of a whole-of-system quality improvement programme at a tertiary hospital in New Zealand.

AIMS: To study in-patient mortality before and after the introduction of a whole-of-system sepsis quality improvement programme at a tertiary hospital in New Zealand. METHODS: The "Raise the Flag" sepsis quality improvement programme was launched in 2018. Discharge coding data were used to identify sepsis cases between May 2015 and July 2021. RESULTS: Of 4,268 cases of sepsis identified, 81% were over 55 years old, 34% were of Maori or Pacific Island ethnicity, 61% had significant co-morbid illness and over two thirds (68%) lived in the two highest quintiles of socio-economic deprivation. The adjusted odds of in-patient mortality were lower in the post-launch period (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.7-0.98, p<0.05), and were higher in association with age (aOR 1.04 for every additional year of age, 95% CI 1.03-1.05, p<0.01), socio-economic status (aOR 1.47 comparing the highest quintile of socio-economic deprivation with the lowest, 95% CI 1.06-2.04, p=0.02) and comorbidity (aOR 2.42 comparing a comorbidity score of 1 with a score of 0, 95% CI 2.1-3.52, p<0.01). CONCLUSION: In patients with a sepsis diagnosis, the odds of in-patient death were lower following the launch of the Raise the Flag sepsis quality improvement programme.

Raise the Flag I: the impact of a sepsis quality improvement programme on delivery of a sepsis resuscitation bundle at a tertiary hospital in New Zealand.

AIMS: To study changes in sepsis resuscitation practice at a tertiary hospital before and after the introduction of a quality improvement programme, and to identify variables associated with its delivery. METHODS: "Raise the Flag", a quality sepsis programme, including the Sepsis Six, was launched in 2018. Adult patients with sepsis were sampled prior to the intervention and during two subsequent periods. RESULTS: Clinicians were more likely to deliver the resuscitation bundle in the post-implementation period (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.27-3.79, p=0.005). This was not sustained at 18-30 months (aOR 1.22, 95% CI 0.89-1.66, p=0.21). After adjusting for potential confounders, each additional decade of patient age was associated with reduced odds of receiving the bundle (aOR 0.83, 95% CI 0.73-0.95, p=0.005). Admission to intensive care increased in the combined post-implementation periods (aOR 2.81, 95% CI 1.13-6.97, p=0.03). CONCLUSION: The odds of receiving a resuscitation bundle improved immediately following the launch of the Raise the Flag programme. Resuscitation practice differed based on patient age. Odds of admission to intensive care were increased.