Frontiers in health services · 2026
A standardized educational implementation strategy improves operational Code Sepsis knowledge in a high-complexity hospital in Colombia.
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Castillo-Morales Laura M, Vega-Useche Camilo, Devia Jaramillo Germán
Аннотация
BACKGROUND: Timely recognition and early bundle-based care are essential to improve sepsis outcomes. However, implementation gaps persist in routine hospital practice, particularly in middle-income settings where multidisciplinary coordination and operational knowledge of institutional protocols are critical. This study evaluated the effect of a standardized educational strategy on immediate Code Sepsis knowledge among hospital personnel in a high-complexity hospital in Colombia.
METHODS: We conducted a single-group quasi-experimental before-and-after study in 2025 among clinical and non-clinical hospital personnel who voluntarily attended a 45-minute in-person multidisciplinary training session on the institutional Code Sepsis strategy. Participants completed a 12-item expert-reviewed assessment before and after intervention. Because one implementation-status item presented a postintervention response-format artifact, the primary outcome was an 11-item knowledge score ranging from 0 to 11. Strict linkage yielded 591 complete pre-post pairs. Paired score changes were evaluated using bootstrap confidence intervals, the Wilcoxon signed-rank test, and rank-biserial correlation. Item-level changes were assessed using McNemar's test with false discovery rate adjustment, while generalized estimating equations were used to estimate the overall postintervention change in the odds of a correct response.
RESULTS: The mean 11-item score increased from 5.80 to 9.22. The paired mean increase was 3.42 points (95% CI, 3.20-3.64), representing 31.1% of the total possible score range. The median paired increase was 3.0 points, and the rank-biserial correlation was 0.9646, indicating a very large favorable paired effect. Overall, 88.0% of participants improved, whereas 5.4% obtained a lower postintervention score. All 11 items improved after false discovery rate correction. Correct item-level responses increased from 52.7% to 83.8%, and postintervention assessments were associated with 5.63-fold higher odds of a correct response (95% CI, 5.05-6.28; p < 0.001). Sensitivity analyses yielded closely similar estimates, supporting the consistency of the observed improvement.
CONCLUSIONS: A brief, standardized, multidisciplinary educational strategy was associated with a substantial and consistently favorable immediate improvement in operational Code Sepsis knowledge among hospital personnel. These findings reflect immediate knowledge acquisition and should not be extrapolated to long-term retention, changes in clinical practice, or patient outcomes.
METHODS: We conducted a single-group quasi-experimental before-and-after study in 2025 among clinical and non-clinical hospital personnel who voluntarily attended a 45-minute in-person multidisciplinary training session on the institutional Code Sepsis strategy. Participants completed a 12-item expert-reviewed assessment before and after intervention. Because one implementation-status item presented a postintervention response-format artifact, the primary outcome was an 11-item knowledge score ranging from 0 to 11. Strict linkage yielded 591 complete pre-post pairs. Paired score changes were evaluated using bootstrap confidence intervals, the Wilcoxon signed-rank test, and rank-biserial correlation. Item-level changes were assessed using McNemar's test with false discovery rate adjustment, while generalized estimating equations were used to estimate the overall postintervention change in the odds of a correct response.
RESULTS: The mean 11-item score increased from 5.80 to 9.22. The paired mean increase was 3.42 points (95% CI, 3.20-3.64), representing 31.1% of the total possible score range. The median paired increase was 3.0 points, and the rank-biserial correlation was 0.9646, indicating a very large favorable paired effect. Overall, 88.0% of participants improved, whereas 5.4% obtained a lower postintervention score. All 11 items improved after false discovery rate correction. Correct item-level responses increased from 52.7% to 83.8%, and postintervention assessments were associated with 5.63-fold higher odds of a correct response (95% CI, 5.05-6.28; p < 0.001). Sensitivity analyses yielded closely similar estimates, supporting the consistency of the observed improvement.
CONCLUSIONS: A brief, standardized, multidisciplinary educational strategy was associated with a substantial and consistently favorable immediate improvement in operational Code Sepsis knowledge among hospital personnel. These findings reflect immediate knowledge acquisition and should not be extrapolated to long-term retention, changes in clinical practice, or patient outcomes.