Background

Sepsis accounts for over 8000 deaths each year in Australia [1]. Sepsis screening and management tools have been recommended but there is a lack of high-quality evidence. 

 

Objective 

We evaluated the impact of the implementation of a sepsis pathway in the Emergency Department (ED) at Royal Perth Hospital in March 2019.

 

Methods

All patients with suspected sepsis admitted via the ED during the calendar years 2019 and 2020 were identified. Patients were classified into four groups: infection, sepsis, septic shock and non-infection according to the Sepsis 3 Criteria [2]. Patients with evidence of use of the sepsis pathway were compared to those without.

 

Results

Data were available for 595 patients of whom 214 (36%) had a sepsis pathway. Patient characteristics are shown in Table 1. Sepsis pathway use was associated with a shorter time to antibiotics, a larger IV fluid volume and higher rate of lactate testing, but no difference in the rate of collection of two sets of blood cultures (Table 2). There was no difference in rate of admission to intensive care, length of stay or representation to hospital. After controlling for baseline risk, mortality within 30 days was significantly lower in the pathway group; adjusted OR 0.43 (95% CI 0.19-0.92), p=0.03. 

 

Conclusion

In this retrospective observational study, using robust objective sepsis classification criteria, use of a sepsis pathway was associated with greater compliance with treatment recommendations [3] and with lower mortality within 30 days. 

 

References

1.     Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England) 2020;395(10219):200-11.

 

2.     Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-10.

 

3.     Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard [Internet]. Sydney NSW: Australian Commission on Safety and Quality in Health Care; 2022 [updated 2022 Jun 30; cited 2022 Jul 21]. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/sepsis-clinical-care-standard