Keywords
Quality improvement
Emergency medicine
Antimicrobial therapy
Clinical Audit
How to Cite
Abstract
Background: This audit aims to assess the care of sepsis at Goulburn Valley Health by comparing current practice with national benchmarks and the local sepsis protocol. The secondary objectives explore relationships between different clinical factors and sepsis care to provide insights that may guide future studies.
Method: The audit was conducted in the Emergency Department at Goulburn Valley Hospital in Shepparton. It involved a retrospective review of both electronic and paper medical records for patients diagnosed with sepsis. Included participants were patients admitted with sepsis or septic shock between January 1, 2023, and March 31, 2023. Key measurements included adherence to the local sepsis pathway, time from triage to intravenous fluids, time from triage to intravenous antibiotics, and compliance with the electronic Therapeutic Guidelines (eTG) for initial treatment. Additional measurements included time from triage to blood cultures, lactate trends, and adequacy of fluid resuscitation.
Results: The median time from triage to fluid resuscitation was 51 minutes (IQR 32–91.5). The median time from triage to antimicrobial infusion was 68 minutes (IQR 48–117). Overall, 59% of patients received appropriate antimicrobial coverage, while 41% did not.
Conclusion: The median infusion times compared favorably with the national pilot under the definitions used; however, differences in time-zero definitions, selection criteria, and a small sample size limit direct comparison. A notable proportion of patients did not receive appropriate antimicrobial coverage. Based on these findings, improvements in sepsis management are recommended, including implementing a sepsis bundle dashboard and strengthening antimicrobial stewardship efforts.
References
1. Australian Commission on S, Quality in Health C. Sepsis Clinical Care Standard. ACSQHC; 2022.
2. Australian Commission on S, Quality in Health C. Sepsis Medical Record Review: Pilot Study. ACSQHC; 2022.
3. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019: 2050312119835043 [PMID: 30915218, https://doi.org/10.1177/2050312119835043]
4. Ore T. Trends and disparities in sepsis hospitalisations in Victoria, Australia. Aust Health Rev. 2016: 511 [PMID: 26654709, https://doi.org/10.1071/AH15106]
5. Prasad PA, Fang MC, Abe-Jones Y, Calfee CS, Matthay MA, Kangelaris KN. Time to Recognition of Sepsis in the Emergency Department Using Electronic Health Record Data: A Comparative Analysis of Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment, and Quick Sequential Organ Failure Assessment. Crit Care Med. 2020: 200 [PMID: 31939788, https://doi.org/10.1097/CCM.0000000000004132]
6. Bishop JL, Schulz TR, Kong DCM, James R, Buising KL. Similarities and differences in antimicrobial prescribing between major city hospitals and regional and remote hospitals in Australia. Int J Antimicrob Agents. 2019: 171 [PMID: 30722961, https://doi.org/10.1016/j.ijantimicag.2018.10.009]
7. Australian Commission on S, Quality in Health C. National Sepsis Program. 2023.
8. Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007: 1105 [PMID: 17334251, https://doi.org/10.1097/01.CCM.0000259463.33848.3D]
9. Kumar A. Early antimicrobial therapy in severe sepsis and septic shock. Curr Infect Dis Rep. 2010: 336 [PMID: 21308515, https://doi.org/10.1007/s11908-010-0128-x]
10. D'Onofrio V, Meersman A, Magerman K, Waumans L, van Halem K, Cox JA, van der Hilst JC, Cartuyvels R, Messiaen P, Gyssens IC. Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes. Int J Antimicrob Agents. 2021: 106379 [PMID: 34161787, https://doi.org/10.1016/j.ijantimicag.2021.106379]
11. Khanina A, Cairns KA, McGloughlin S, Orosz J, Bingham G, Dooley M, Cheng AC. Improving sepsis care for hospital inpatients using existing medical emergency response systems. Infect Dis Health. 2020: 63 [PMID: 31740379, https://doi.org/10.1016/j.idh.2019.10.003]
12. Venkatesh B, Schlapbach L, Mason D, Wilks K, Seaton R, Lister P, Irwin A, Lane P, Redpath L, Gibbons K, Ergetu E, Rice M. Impact of 1-hour and 3-hour sepsis time bundles on patient outcomes and antimicrobial use: A before and after cohort study. Lancet Reg Health West Pac. 2022: 100305 [PMID: 35024649, https://doi.org/10.1016/j.lanwpc.2021.100305]
13. Arulappen AL, Danial M, Ng LW, Teoh JC. The Impact of Antibiotics Administration on Mortality for Time in Sepsis and Septic Shock Patients including Possible Reasons for Delayed Administration in Malaysia. Antibiotics (Basel). 2022: [PMID: 36139981, https://doi.org/10.3390/antibiotics11091202]
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 ASIDE Health Sciences