Volume 16 Supplement 3
Audit of the ward-based management of severe sepsis in a large teaching hospital
© Estebanez and Cole; licensee BioMed Central Ltd. 2012
Published: 14 November 2012
The Surviving Sepsis 6-hour bundle  was created to promote effective identification and management of patients with severe sepsis and septic shock. Efficient and timely implementation of the 6-hour bundle including early intravenous antibiotics has been shown to improve patient outcome . We aimed to determine the efficiency of severe sepsis identification, implementation of the 6-hour bundle and overall management of ward-based patients.
During a 4-month period, ward-based patients with severe sepsis were identified by nurse practitioners and the critical care outreach team at a large teaching hospital in North West England. Analysis of patient medical records was performed to assess the efficiency and quality of care received compared with the gold standard sepsis 6-hour bundle. Promptness of doctor attendance and patient 30-day outcome were also analysed.
Characteristics and management data for patients with severe sepsis comparing patients who were deceased with patients discharged home at 30 days
Patients discharged home at 30 days (n= 13)
Patients deceased at 30 days (n= 7)
Median age (years)
Median time taken to be seen by doctor after time 0 (minutes)
Median MEWS at time 0
Median MEWS at doctors' attendance
Timely antibiotics given
Basic resuscitation undertaken (oxygen, i.v. fluids, urinary catheter, ABG)
Despite the widespread recognition of patients with severe sepsis, underperformance of the 6-hour bundle remains a major factor in suboptimal management of ward-based patients. Increased delay from the onset of severe sepsis until doctor review is associated with increased risk of mortality despite better adherence to the 6-hour bundle. Further education of doctors and nursing staff, regarding the importance of the 6-hour sepsis bundle, in addition to the implementation of strategies to improve the early identification and timely review of ward-based patients with severe sepsis are recommended.
Olivia O'Gara and Jonathan Walker are contributing authors.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.