Cross-sectional study on emergency department management of sepsis

Abstract

Introduction: Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs’ processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions.

Methods: Structured telephone interviews based on the United Kingdom Sepsis Trust ‘Exemplar Standards for the Emergency Management of Sepsis’ were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators.

Results: Sixteen of the 18 public EDs in Hong Kong participated in the study. Among various time-critical medical emergencies such as major trauma, sepsis was perceived by the interviewees to be the leading cause of in-hospital mortality and the second most important preventable cause of death. However, only seven EDs reported having departmental guidelines on sepsis care, with four adopting the Quick Sequential Organ Failure Assessment score or its modified versions. All responding EDs reported that antibiotics were stocked within their departments, and all EDs with sepsis guidelines mandated early intravenous antibiotic administration within 1 to 2 hours of detection. Reported major barriers to optimal sepsis care included lack of knowledge and experience, nursing human resources shortages, and difficulty identifying patients with sepsis in the ED setting.

Conclusion: There are considerable variations in sepsis care among EDs in Hong Kong. More training, resources, and research efforts should be directed to early ED sepsis care, to improve patient outcomes.

引言：急症室於及早辨識和處理膿毒症（又稱敗血症）中發揮重要作用。然而，人們對本地急症室的膿毒症護理過程、國際建議的應用，以至2016年膿毒症第三版國際共識定義的影響所知甚少。 方法：本研究於2017年1月至8月期間，根據英國膿毒症信託基金會發佈的膿毒症應急管理範例標準，與香港公立醫院急症室代表進行結構性電話訪談，隨後對各間醫院及部門膿毒症指南進行審查。 結果：在香港18間公立醫院急症室中，共16間參與研究。在各種包括嚴重創傷等時間緊迫的醫療緊急事件中，受訪者認為膿毒症是院內死亡的主因，也是第二重要的可預防死因。然而，只有7間公立醫院急症室報告有膿毒症護理的部門指引，其中4名採用快速序貫器官衰竭評分（qSOFA）或其修訂版。所有回應者均報告有存放抗生素，而持有膿毒症指南的急症室均要求檢測後1至2小時內進行早期抗生素靜脈注射。缺乏知識和經驗、人力資源短缺，以及在急症室環境中難以識別膿毒症患者皆為膿毒症護理的主要障礙。 結論：香港公立醫院急症室的膿毒症處理有頗大差異。建議加強針對早期急症室膿毒症護理的培訓、資源和研究工作，以改善治療效果。