Quick recognition and appropriate treatment of sepsis are critical determinants for patients with sepsis treated in the ED.
Surviving Sepsis Campaign Recommendation: Administration of effective intravenous antimicrobials within the first hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C) as the goal of therapy.
The recognition of severe sepsis was measured as Time of the Initial Lactate Results (Lactate>= 2.0). The individual physician performance was compared to their peers in the individual reports.
The “Sepsis in the ED” project provided Calgary emergency physicians with information over a three-year period about their management of patients with severe sepsis compared to their peers.
A previous study done in Calgary in 2006 implemented an Emergency Department (ED) sepsis protocol with a view to rapidly identify patients with severe sepsis, institute early and aggressive resuscitation and reduce the overall time for the patient to receive antibiotics. The “Sepsis in the Emergency Department” project is intended to ascertain whether previously attained Calgary emergency physician improvements in time to antibiotic treatment for emergency department patients meeting criteria for severe sepsis have been sustained over time by providing participating emergency physicians practice-specific data on the individual and aggregate care received by their patients with severe sepsis.
The patient visits, lab and antibiotic ordering data for adult patients with severe sepsis from 2011 to 2013 were retrieved from REDIS (Regional Emergency Department Information System) and SCM (Sunrise Clinical Manager). As the vital signs were not recorded electronically, to provide the best surrogate identification of severe sepsis patient visits, the project expert panel suggested using a combination of patients with initial lactate result of greater than or equal to 2 mmol/L and Infection-related primary admitting diagnosis.
The median time from initial lactate result to first antibiotics administration in the four Calgary hospitals are all within the one-hour frame and thus meets the Surviving Sepsis Campaign Guideline recommendation. Over 56.63% of all the severe sepsis visits had antibiotics ordered within one-hour frame which represents a marked improvement from the assessment in 2006 (38.5%) 1.
The individual reports were provided to 78 consenting emergency physicians. A rounds presentation on sepsis and a short feedback session was held in 2014. The Emergency Department recognized the project’s value and has since incorporated the Sepsis measures used in this project to their own departmental performance dashboard.
References, More Information, and Education Resources
Francis, M., et al (2010). Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis. Canadian journal of emergency medicine, 12(4), 202-310.