Quality of sepsis management in the Emergency Department at Goulburn Valley Health, Victoria, Australia: A Retrospective Audit

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.