title: The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.
abstract: OBJECTIVE
  To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics.
  
  
  BACKGROUND
  Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear.
  
  
  METHODS
  A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication).
  
  
  RESULTS
  This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant.
  
  
  CONCLUSIONS
  The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department.
  
  
  CONCLUSIONS
  The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of best practice and improving patient care.
authors.affiliation: Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.|Emergency Department St George Hospital, South Eastern Sydney Local Health District, Kogarah, NSW, Australia.
authors.forename: Bernadine
authors.identifier: http://orcid.org/0000-0002-9143-1986
authors.initials: B
authors.lastname: Romero
authors.affiliation: Northern Sydney Local Health District, St Leonards, NSW, Australia.|Research and Practice Development, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.affiliation: Mental Health Drug and Alcohol Nursing, Northern Sydney Local Health District, St Leonards, NSW, Australia.|School of Nursing, Midwifery & Paramedicine (NSW & ACT), Australian Catholic University, North Sydney, NSW, Australia.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-3831-537X
authors.initials: M
authors.lastname: Roche
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000066491:Clinical Decision-Making / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents
keywords: assessment; clinical guidelines; emergency; emergency care; sepsis