The impact of evidence-based sepsis guidelines on emergency department clinical practice: A pre-post medical record audit

Journal article


Romero, Bernadine, Fry, Margaret and Roche, Michael. (2017) The impact of evidence-based sepsis guidelines on emergency department clinical practice: A pre-post medical record audit. Journal of Clinical Nursing. 26(21-22), pp. 3588 - 3596. https://doi.org/10.1111/jocn.13728
AuthorsRomero, Bernadine, Fry, Margaret and Roche, Michael
Abstract

Aims and objectives: To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Background: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. Design/Methods: A 12‐month pre‐post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). Results: This study demonstrated a statistically significant 230‐minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758‐minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. Conclusions: The findings highlight the impact the guidelines can have on clinician decision‐making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. Relevance to clinical practice: The use of evidenced‐based guidelines can impact clinical decision‐making and behaviour, resulting in the translation and support of best practice and improving patient care.

Keywordsassessment; clinical guidelines; emergency; emergency care; sepsis
Year2017
JournalJournal of Clinical Nursing
Journal citation26 (21-22), pp. 3588 - 3596
PublisherWiley-Blackwell
ISSN1365-2702
Digital Object Identifier (DOI)https://doi.org/10.1111/jocn.13728
Scopus EID2-s2.0-85017630388
Page range3588 - 3596
Research GroupSchool of Nursing, Midwifery and Paramedicine
Publisher's version
File Access Level
Controlled
Place of publicationUnited Kingdom
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