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PWE-411 Sepsis in surgical patients – are we good enough?
  1. PB Sarmah,
  2. N Green,
  3. H Youssef
  1. Heart of England NHS Foundation Trust, Birmingham, UK

Abstract

Introduction Sepsis is a leading cause of morbidity and mortality in the UK, with diagnosis and treatment being highlighted nationally by the UK Sepsis Trust. Our aim was to assess if sepsis is appropriately recognised and managed in acute surgical admissions using the systemic inflammatory response syndrome (SIRS) criteria and Sepsis 6 as per Trust and national guidelines.

Method A prospective audit was conducted, focusing on the initial assessment by a surgical doctor for all acute surgical admissions over 14 days. Notes were reviewed for documented evidence of SIRS criteria, infection and Sepsis 6 bundle. Our standards were taken from the UK Sepsis Trust guidelines. A re-audit following departmental education for all grades of doctors was performed after 3 months.

Results 102 patients were included in the audit. No patient was fully assessed for SIRS criteria, correlating with a missed diagnosis in 7 patients who presented with sepsis. The most frequently neglected SIRS criteria were mental state and glucose (not assessed in 83/102 and 98/102 respectively). None of the patients identified as septic during data collection had the full Sepsis 6 bundle implemented, although all were given antibiotics and intravenous (IV) fluids. None were given supplementary oxygen. Re-audit identified 78 patients for inclusion. Diagnosis of sepsis improved to 22% (total of 18 septic patients), again with mental state and glucose being overlooked frequently. However, implementation of the Sepsis 6 bundle was more varied, with fewer patients receiving antibiotics (11/18) and IV fluids (13/18) but an increase in the percentage receiving supplementary oxygen (5%). 100% of patients with infection were diagnosed as such in both the audit and re-audit.

Conclusion The audit identified poor diagnosis but consistent delivery of antibiotics and IV fluids, which challenged initial assumptions of good diagnosis with poor management. The re-audit highlighted improvements in diagnosis suggesting that re-education with respects to SIRS criteria had worked to a degree. However, the poorer levels of implementation of the Sepsis 6 were unexpected. On reflection, this may have been due to rotation of junior doctors out of the department, as the new cohort were not given formal re-education. We must endeavour to identify interventions that lead to a sustainable rise in standards despite personnel changes, and ensure these interventions to improve patient safety are introduced early to new cohorts of doctors.

Disclosure of interest None Declared.

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