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Impact of the Surviving Sepsis Campaign on the recognition and management of severe sepsis in the emergency department: are we failing?
  1. Helen Lindsay Cronshaw1,
  2. Ron Daniels2,
  3. Anthony Bleetman3,
  4. Emma Joynes4,
  5. Mark Sheils5
  1. 1Emergency Department, Leicester Royal Infirmary, UK
  2. 2Intensive Care unit, Good Hope Hospital, Birmingham, UK
  3. 3Emergency Department, Good Hope Hospital, Birmingham, UK
  4. 4Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
  5. 5Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Helen Lindsay Cronshaw, Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; hcronshaw{at}doctors.org.uk

Abstract

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.

Objectives 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.

  • Sepsis
  • shock
  • emergency medicine
  • intensive care
  • lactate
  • infectious diseases
  • intensive care
  • management
  • emergency department management
  • wounds
  • infection

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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