I am currently focusing on improving our management of sepsis in ED. We have completed an initial phase, which highlights the challenges of managing sepsis in a low acuity area.
Abstract Title: Managing sepsis in the Emergency Department. Is 'quick Sequential Organ Dysfunction Assessment' score (qSOFA) comparable to 'Systemic Inflammatory Response Syndrome' (SIRS), at identifying patients with sepsis in our low acuity patient population?
'The Third International Consensus Definitions for Sepsis and Septic Shock' (Sepsis-3) 2015, released a validated screening tool for sepsis called the quick Sequential Organ Failure Assessment :(qSOFA) score (AUC 0.81), and consists of 3 simple criteria, where meeting two or more criteria is associated with poor outcomes due to sepsis:
• An alteration in mental status
• A decrease in systolic blood pressure < 100 mm Hg
• A respiration rate > 22 breaths/min
We aim to discover whether a recently developed, 'qSOFA' has a high predictive power (i.e. sensitivity and specificity), to identify those with serious infection (sepsis), from patients with a simple inflammatory response to infection. Once we have identified which tool works better in our population, we aim to trial the implementation of a 'Rapid Sepsis Response' pathway in the assessment area. This is vital because each hour delay to antibiotics results in a 7% mortality increase, and our current time to antibiotics in the assessment area is over 2 hours. Recent Emergency Department data has led us to question the effectiveness of our current sepsis algorithm based on 6 SIRs criteria, in a low acuity area. Our current screening tool when applied in 'Acute Assessment', has a high specificity 95% (CI 88.5-98.7), but low sensitivity 57% (CI 34.0-78.1).This results in unnecessary attention, from our predominantly junior team, to patients with a low risk of mortality, and delays in care to those that have a higher mortality, unless antibiotics are started within 1 hour. We hope will provide the best pathway to timely treatment and improved outcomes. Results will provide foundation for phase II of our study, which proposes a new pathway that provides better diagnosis of sepsis patients from the Emergency Department.
Counties Manukau Health