The outcomes for patients with acute sepsis are improved by timely resuscitation and appropriate antibiotic administration, an Irish study at the International Conference on Emergency said.
A team from St James’ Hospital performed a retrospective audit of 150 patients, analysing data on demographics, triage observations, time to antibiotic administration, blood cultures and lactate measurements.
“As part of a quality initiative we undertook an audit of sepsis care in patients presenting to a busy urban ED, which frequently suffers with overcrowding. Our aim was to optimise compliance with the ED sepsis six-care bundle and with antimicrobial guidelines,” the study said.
In the study the team compared the selection of antibiotics to hospital guidelines. Furthermore, the team implemented a number of organisational changes in the ED to improve sepsis care, for example changes were introduced at triage to allow early identification of SIRS (systemic inflammatory response syndrome), a sepsis care pathway including information on optimum selection of antibiotics for common sources of sepsis was introduced, and education of multi-disciplinary team was undertaken.
“We have successfully implemented a number of changes to improve the care of sepsis patients by using action learning methodology recommended to solve complex problems embedded in a team and organisational learning environment,” the team explained.
The initial audit identified under-triage of 21 per cent of SIRS patients, also the median time from triage to antibiotics was 126 minutes. Median time from medical assessment to antibiotics was found to be 60 minutes. Furthermore, 38 per cent of patients received antibiotics within 1 hour of presentation, with 89 per cent receiving antibiotics within 4 hours. The study also found that 30 per cent of antibiotic prescriptions did not comply with hospital guidelines.
Following initiatives to improve patient care, a further audit was undertaken. In this study 52 patients over a 2 month period were studied, and 100 per cent of patients with SIRS were appropriately triaged.
During this study the team found that the median time to antibiotics improved; 109 minutes, compared with 126 minutes previously. Time from medical assessment to antibiotics also improved; 45 minutes compared with 60 minutes, and 21 per cent of patients received antibiotics within 1 hour, while 87 per cent received antibiotics within 4 hours. Furthermore almost all patients, 94 per cent, managed with the Sepsis Care Pathway received appropriate antibiotics.