Impact of the Surviving Sepsis Campaign on the recognition and management of severe sepsis in the emergency department: are we failing?
BACKGROUND
Severe sepsis/septic shock (SS/SS) has a high mortality. The past decade lays witness to a concerted international effort to tackle this problem through the Surviving Sepsis Campaign (SSC). However, bundle delivery remains problematic. In 2009, the College of Emergency Medicine (CEM) set out guidelines for the management of SS/SS. These set the standards for this audit.


OBJECTIVE
To assess the recognition and management of patients presenting with SS/SS across three emergency departments (EDs) within the West Midlands.


METHODS
Data were collected retrospectively over a 3-month period. Patients in the ED with a diagnostic code of, or presenting complaint suggestive of, sepsis, had their scanned notes assessed for evidence of SS/SS. Compliance with the CEM guidelines, and evidence of referral to the intensive care staff was evaluated.


RESULTS
255 patients with SS/SS were identified. Of these, 17% (44/255) were documented as septic by ED staff. The CEM standard of care was received in 41% of those with a documented diagnosis of severe sepsis in the ED, and 23% of patients with SS/SS overall. 89% of patients received the 'treatment' aspects of care: oxygen, IV antibiotics and IV fluids. Twelve patients with a raised lactate level and normal blood pressure (cryptic shock) failed to receive fluid resuscitation. 71% of patients with SS/SS had no documented discussion or consideration of referral to the intensive care unit.


CONCLUSIONS
The SSC has had some impact; however, there is still a long way to go. It is assumed that the picture is similar in EDs across the UK and recommendations are made based on these local findings.
Cronshaw
Helen Lindsay
HL
Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. hcronshaw@doctors.org.uk
Daniels
Ron
R
Bleetman
Anthony
A
Joynes
Emma
E
Sheils
Mark
M
D000328:Adult; D000368:Aged; D054869:Clinical Audit; D003422:Critical Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D055815:Young Adult