{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:07Z","timestamp":1790790787406,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013post 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean 11-item score increased from 5.80 to 9.22. The paired mean increase was 3.42 points (95% CI, 3.20\u20133.64), 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\u20136.28;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Sensitivity analyses yielded closely similar estimates, supporting the consistency of the observed improvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1907012","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:38:47Z","timestamp":1785821927000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A standardized educational implementation strategy improves operational Code Sepsis knowledge in a high-complexity hospital in Colombia"],"prefix":"10.3389","volume":"6","author":[{"given":"Laura M.","family":"Castillo-Morales","sequence":"first","affiliation":[{"name":"Department of Critical Medicine and Intensive Care, Fundaci\u00f3n Santa Fe de Bogot\u00e1","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo","family":"Vega-Useche","sequence":"additional","affiliation":[{"name":"Department of Critical Medicine and Intensive Care, Fundaci\u00f3n Santa Fe de Bogot\u00e1","place":["Bogot\u00e1, Colombia"]},{"name":"Universidad Pedag\u00f3gica y Tecnol\u00f3gica de Colombia","place":["Tunja, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germ\u00e1n","family":"Devia Jaramillo","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad del Rosario","place":["Bogot\u00e1, Colombia"]},{"name":"Emergency Department, Fundaci\u00f3n Santa Fe de Bogot\u00e1","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"J Am Med Assoc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the global burden of disease study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1001\/JAMA.2014.5804","article-title":"Hospital deaths in patients with sepsis from 2 independent cohorts","volume":"312","author":"Liu","year":"2014","journal-title":"J Am Med Assoc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1097\/CCM.0B013E318218A35E","article-title":"The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals","volume":"39","author":"Rodr\u00edguez","year":"2011","journal-title":"Crit Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"33","DOI":"10.2147\/OAEM.S289148","article-title":"USER protocol as a guide to resuscitation of the patient with septic shock in the emergency department","volume":"13","author":"Jaramillo","year":"2021","journal-title":"Open Access Emerg Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1056\/NEJMP1707170","article-title":"Recognizing sepsis as a global health priority\u2014a WHO resolution","volume":"377","author":"Reinhart","year":"2017","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/S00134-021-06506-Y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s00134-026-08360-2","article-title":"Surviving sepsis campaign international guidelines for the management of sepsis and septic shock in children 2026","volume":"52","author":"Weiss","year":"2026","journal-title":"Intensive Care Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s00134-018-5085-0","article-title":"The surviving sepsis campaign bundle: 2018 update","volume":"44","author":"Levy","year":"2018","journal-title":"Intensive Care Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1007\/s00134-014-3496-0","article-title":"Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study","volume":"40","author":"Levy","year":"2014","journal-title":"Intensive Care Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0125827","DOI":"10.1371\/JOURNAL.PONE.0125827","article-title":"Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies","volume":"10","author":"Damiani","year":"2015","journal-title":"PLoS One"},{"key":"B12","doi-asserted-by":"publisher","first-page":"767","DOI":"10.3390\/JCM15020767","article-title":"Implementation of a sepsis code protocol at an academic institution in Colombia: a pilot study","volume":"15","author":"Jaramillo","year":"2026","journal-title":"J Clin Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1056\/NEJMOA1703058","article-title":"Time to treatment and mortality during mandated emergency care for sepsis","volume":"376","author":"Seymour","year":"2017","journal-title":"N Engl J Med"},{"key":"B14","first-page":"400","article-title":"Documento de consenso para la implantaci\u00f3n y desarrollo del C\u00f3digo Sepsis en la Comunidad de Madrid","volume":"32","author":"Palencia Herrej\u00f3n","year":"2019","journal-title":"Rev Esp Quimioter"},{"key":"B15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.medin.2019.05.008","article-title":"C\u00f3digo Sepsis Interhospitalario en Catalunya: modelo organizativo territorial para la atenci\u00f3n inicial al paciente con sepsis","volume":"44","author":"Y\u00e9benes","year":"2020","journal-title":"Med Intensiva"},{"key":"B16","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/S00134-025-08284-3","article-title":"The next frontier in sepsis: connected ICU data for real-world clinical decision making","volume":"52","author":"Carbajo","year":"2026","journal-title":"Intensive Care Med"},{"key":"B17","first-page":"154","article-title":"Evaluaci\u00f3n de los resultados antes y despu\u00e9s de la implantaci\u00f3n del C\u00f3digo Sepsis en Arag\u00f3n","volume":"29","author":"Ferreras Amez","year":"2017","journal-title":"Emergencias"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1097\/01.CCM.0000298122.49245.D7","article-title":"Barriers to implementing protocol-based sepsis resuscitation in the emergency department\u2013results of a national survey","volume":"35","author":"Carlbom","year":"2007","journal-title":"Crit Care Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"R409","DOI":"10.1186\/CC2959","article-title":"An international sepsis survey: a study of doctors\u2019 knowledge and perception about sepsis","volume":"8","author":"Poeze","year":"2004","journal-title":"Crit Care"},{"key":"B20","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/J.JCRC.2010.03.012","article-title":"Survey on physicians\u2019 knowledge of sepsis: do they recognize it promptly?","volume":"25","author":"Assun\u00e7\u00e3o","year":"2010","journal-title":"J Crit Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"232","DOI":"10.2478\/JCCM-2022-0024","article-title":"Knowledge, practice and attitudes to the management of sepsis in Jamaica","volume":"8","author":"Roye-Green","year":"2022","journal-title":"J Crit Care Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/J.JHIN.2022.01.004","article-title":"Impact of sepsis education for healthcare professionals and students on learning and patient outcomes: a systematic review","volume":"122","author":"Choy","year":"2022","journal-title":"J Hosp Infect"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1001\/JAMA.299.19.2294","article-title":"Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain","volume":"299","author":"Ferrer","year":"2008","journal-title":"J Am Med Assoc"},{"key":"B24","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/CJ9.0000000000000090","article-title":"The declaration of S\u00e3o Paulo: sepsis as the main cause of preventable death and disability in Latin America. A call to action in order to reduce the burden of sepsis","volume":"47","author":"Jaimes","year":"2019","journal-title":"Colomb J Anesthesiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/nur.20199","article-title":"Is the CVI an acceptable indicator of content validity? Appraisal and recommendations","volume":"30","author":"Polit","year":"2007","journal-title":"Res Nurs Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00006199-198611000-00017","article-title":"Determination and quantification of content validity","volume":"35","author":"Lynn","year":"1986","journal-title":"Nurs Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1111\/1467-9639.00050","article-title":"An introduction to the bootstrap","volume":"23","author":"Johnson","year":"2001","journal-title":"Teach Stat"},{"key":"B28","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Series B Stat Methodol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data analysis using generalized linear models","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1186\/S13054-018-2091-0","article-title":"Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-edusepsis study","volume":"22","author":"Ferrer","year":"2018","journal-title":"Crit Care"},{"key":"B32","doi-asserted-by":"publisher","first-page":"3925","DOI":"10.1038\/S41598-022-07915-9","article-title":"A multifaceted educational intervention improved anti-infectious measures but had no effect on mortality in patients with severe sepsis","volume":"12","author":"Schwarzkopf","year":"2022","journal-title":"Sci Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/S13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s13054-018-2157-z","article-title":"The global burden of sepsis: barriers and potential solutions","volume":"22","author":"Rudd","year":"2018","journal-title":"Crit Care"},{"key":"B35","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/J.JCLINEPI.2013.08.015","article-title":"Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects","volume":"67","author":"McCambridge","year":"2014","journal-title":"J Clin Epidemiol"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1907012\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:38:48Z","timestamp":1785821928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1907012\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":35,"alternative-id":["10.3389\/frhs.2026.1907012"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1907012","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"article-number":"1907012"}}