Surviving Sepsis beyond Intensive Care: A Retrospective Cohort Study of Compliance with the International Guidelines

Abstract

The early recognition and goal-directed management of severely septic patients has been shown to reduce mortality. This study aimed to determine compliance with the ‘Surviving Sepsis' guidelines and to analyse the systems involved in delivering care in a UK teaching hospital. Patients from any hospital department with clinically significant positive blood cultures (n=229) were identified. Adults who met criteria for severe sepsis and who were deemed suitable for active management were included (n=46). None of the patients received all bundle elements within the advised time limits. Only 52% had received broad-spectrum antibiotics within three hours of presentation and only 57% had adequate fluid resuscitation within six hours. The median time from presentation to doctor involvement was 1.1 hours, with a delay of 3.9 hours to see a senior clinician. The median time from presentation to admission to the high dependency unit (HDU) or intensive care unit (ICU) was 12.9 hours. This study has shown that the early recognition and resuscitation of septic patients is unreliable and the capacity to provide early antimicrobial and goal-directed therapy for septic patients is limited in a UK teaching hospital.