Audit of compliance to SEPSIS 6 criteria in Emergency Department admissions

INTRODUCTION

The timely diagnosis of sepsis is the essential first step that activates life-saving pathways. The aim of our study was to assess the accuracy of the ‘sepsis flag’ assigned to patients presenting to our hospital’s Emergency Department (ED).

METHOD

A retrospective two week review (18/03/19 to 25/03/19 and 07/05/19 to14/05/19) was performed in a District General Hospital in London, assessing the medical records of all adult patients assigned a sepsis flag in ED (n=21), in order to assess if SEPSIS 6 criteria were met. For comparison, patients admitted to ED with gram negative bacteraemias (n=8) in the same period were reviewed to check if they were included in the SEPSIS 6 group.

RESULTS

Ten out of twenty one patients with a ‘sepsis flag’ fulfilled criteria. Six other patients had one criterion (T>38oC) for sepsis. Blood cultures were sent in all patients. Four out of ten patients were administered IV antibiotics within one hour. During this period, none of the eight patients admitted with gram negative bacteraemias were assigned a ‘sepsis flag’, despite five of them meeting SEPSIS 6 criteria (two or more criteria) and having evidence of infection. However, the majority (7/8) received IV antibiotics within one hour.

CONCLUSION

Our review highlights the difficulties in the diagnosis of sepsis and the limitations of the SEPSIS 6 criteria for detection of septic patients in triage. However, we have demonstrated that the vast majority of patients had appropriate investigations and prompt antibiotic treatment, irrespective of the ‘sepsis flag’.