Implementation of Guidelines for Sepsis Management in Emergency Departments: A systematic Review

Ms Yasmin Sungkar1,2, Professor Julie Considine2, Associate Professor Anastasia  Hutchinson2
1Northern Health, Epping Melbourne, Australia, 2Deakin University, Burwood Melbourne, Australia

Introduction: Timely, evidence-based emergency care for patients with sepsis  decreases intensive care unit admissions and mortality. Despite international and local campaigns promoting evidence-based criteria for sepsis recognition and guidelines for sepsis management, delays in the care of patients with sepsis is still an important issue in emergency departments (EDs). The primary aim of this systematic review was to examine the effect of implementation of guidelines for the ED management of sepsis had on time to antibiotic administration. Secondary aims were to examine changes in evidence-based sepsis care and patient outcomes.
Method: A systematic literature review of English language publications published in academic databases was performed from 1st January 2002 and 31st May 2016 using search terms related to sepsis, emergency care, guidelines and evidence-based practice. A Population, Intervention, Comparator, Outcome (PICO) assessment was carried out to define the types of studies included in this review. Screening and filtering of search results was reported as per the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.
Results: Nineteen studies were included for analysis: all used longitudinal repeated measures cohort study designs. The studies were of low to moderate methodological quality. Of the 19 studies included, time to antibiotic administration decreased in 18 (95%) studies  and increased in one (5%) study  following guideline implementation. Five studies  reported improvements in compliance with specific elements of sepsis guidelines, and nine studies reported an increase in lactate sampling .  Reductions in inpatient mortality ranging from 1% to 24% were reported in 12 studies with two studies reporting increased mortality after guideline implementation.
Conclusion: Implementation of sepsis management guidelines in EDs improves the timeliness of processes of care and may improve patient outcomes.

Yasmin Sungkar is a Critical Care Registered Nurse currently working in the Emergency Department of The Northern Hospital in Epping Victoria. For the last 5 years, Yasmin has also been involved in a quality improvement project called Step on Sepsis. Step on Sepsis is a Northern Health initiative which aims to improve the early recognition and prompt treatment of patients with or at risk of sepsis. Yasmin has also recently completed her Honors thesis on sepsis guideline implementation in EDs.