Chinese Journal of Emergency and Critical Care Nursing >
Quality improvement strategy and effect evaluation of 1-h bundle for septic shock
Received date: 2025-03-04
Online published: 2026-02-02
Supported by
The Nursing Research Fund of Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology(2022D25)
Objective To investigate the impact of a continuous quality improvement strategy based on the Analysis-Design-Development-Implementation-Evaluation（ADDIE） model on enhancing the compliance of intensive care unit（ICU） medical staff with the 1-hour bundle therapy for septic shock，and its effect on septic shock patients’ clinical outcomes. Methods This study was conducted in the ICU of a tertiary class A hospital in Hubei Province. The study population included patients diagnosed with septic shock and admitted between June 2021 and May 2024. The study adopted a continuous quality improvement design and implemented interventions based on the ADDIE model. It was divided into four phases：baseline data collection and preparation（June 2021 to May 2022），intensive training （June 2022），and two quality improvement cycles（July 2022 to May 2023 and June 2023 to May 2024）. Data were collected on ICU medical staff compliance with the 1-hour bundle，patient ICU length of stay，and in-hospital mortality. The Kruskal-Wallis H test was used to compare length of stay，and the chi-square test was used to compare compliance rates and mortality across phases. Results A total of 396 patients were included，with 87 in the baseline phase，151 in the first quality improvement cycle，and 158 in the second quality improvement cycle. Compliance with each component of the 1-hour bundle showed an overall increasing trend. Statistical analysis revealed significant improvements in all measures across the three time points，except for maintenance of mean arterial pressure≥65 mmHg（1 mmHg=0.133 kPa）（P>0.05）. The in-hospital mortality rate in the second quality improvement cycle（18.35%） was significantly lower than that in the baseline phase（28.74%）（P<0.05）. Conclusion The continuous quality improvement strategy based on the ADDIE model significantly improved compliance of ICU staff with the 1-hour bundle therapy and effectively reduced in-hospital mortality by enhancing the implementation quality of key interventions.
Key words： ADDIE Model; Quality Improvement; Sepsis Shock; 1 Hour Bundle Strategy; Compliance
CUI Mengying , XIAO Qi , ZOU Dengxiu , TAN Kun , DENG Juan , SHANG Weiwei . Quality improvement strategy and effect evaluation of 1-h bundle for septic shock[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026 , 7(2) : 210 -215 . DOI: 10.3761/j.issn.2096-7446.2026.02.015
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