New survey about Sepsis shows low adherence to guidelines in Sepsis cases putting patients at risk

Results:

Sepsis is a life-threatening condition in which the body’s response to infection causes organ damage. Globally, sepsis is now recognised to claim more lives than cancer^{1 2}. Every year in Europe, more than 3.4 million people develop sepsis, of whom 700,000 do not survive ³.

BioMérieux and the UK Sepsis Trust have together commissioned a survey in six European countries to better understand healthcare professionals’ knowledge and practice in the management of sepsis. The main findings of this survey can be summarized as below. To see the full manuscript published in BMJ Open Quality, please click here.

Whilst most surveyed doctors are knowledgeable about Sepsis Bundles*, some cases of sepsis are missed and delays in diagnosis are still present in the hospital where they work.

Despite the fact that 95% of surveyed doctors think that developing sepsis is serious, 66% agree that there is sometimes a delay in diagnosing sepsis and over half (56%) agree that they do miss some cases of sepsis in the hospitals in which they work.

Dr Ron Daniels, world leading sepsis expert and Chief Executive of the UK Sepsis Trust said:

This important research highlights that there remains huge variation between countries in properly implementing internationally supported standards of diagnosis and treatment of sepsis. The stark reality is that there is much more to be done to ensure timely and effective management of Sepsis. As healthcare systems continue to grapple with issues such as staff shortages and evolving patient needs, urgent action must be taken to ensure that there is consistent training on sepsis care to improve patient care and outcomes. Given the high mortality rate of sepsis across Europe, it is clear that governments, policymakers, commissioning bodies and professionals need to urgently address these barriers.

There are a number of barriers to adherence of the Sepsis Bundles

Almost all (96%) of surveyed healthcare professionals state that Sepsis Bundles are followed in their hospital to at least some extent. However, when prompted, only two in five (44%) carry out all steps included in the Hour-1 Sepsis Bundle for diagnosis and treatment of suspected sepsis**, meaning that over half (56%) of patients are not receiving the standard of care, increasing their risk of morbidity and mortality.

This survey identified a number of reasons why there is a lack of adherence to Sepsis Bundles amongst surveyed healthcare professionals. While the main barriers do vary between countries, the main ones identified include high patient caseload (59%), staff shortages (58%), insufficient training (34%) and lack of familiarity with the steps (32%).

Whilst nearly all surveyed respondents (98%) agree early detection of sepsis can lead to significantly better outcomes, one in four (27%) said that a lack of rapid diagnostic tests is one of the main barriers to adhering to the stages outlined in the Sepsis Bundles.

Mark Miller, Executive Vice President and Chief Medical Officer at bioMérieux explained:

Diagnostic tests are vital for anyone suspected of sepsis, providing critical information on its presence and severity, the type and extent of infection at the source, how best to manage the patient and also to monitor their progress. Tests like blood cultures, other appropriate cultures, lactate and procalcitonin can give essential information for guiding optimal patient care in suspected and proven sepsis.

More staff and training are selected as the top two areas to address existing knowledge gaps amongst healthcare professionals, and hence improve patient outcomes

From a list of actions, surveyed doctors are most likely to believe that more staff (66%), receiving training on what Sepsis Bundles are (54%) and rapid diagnostic tests (45%) would improve adherence to these bundles in the hospitals within which they work.

In 2021, bioMérieux and the UK Sepsis Trust published the results of a separate survey showing the need to accelerate awareness and education of the general population about Sepsis. This current survey is an evolution of the campaign, aiming to enhance awareness amongst healthcare professionals and institutions in order to improve patient care with crucial and timely diagnostics, and promote better adherence to international sepsis care guidelines.

Notes:

* Hour-1 Sepsis Bundle includes a set of interventions which are recommended to begin immediately in all patients with suspected sepsis or septic shock.
** Correctly selected actions include: measure lactate level and re-measure if the initial level is elevated; obtain blood cultures before administering antibiotics; administer broad-spectrum antibiotics; administer IV fluid; rapid administration of 30ml/kg crystalloid for hypotension or lactate ≥ 4mmol/l; apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥ 65mmhg.

Technical note:

On behalf of BioMérieux and the UK Sepsis Trust, Ipsos conducted an online survey among 368 health professionals across 6 countries (UK n=100, France n=100, Spain n=100, Sweden n=50, Denmark n=16, Norway n=2) between 20th June and 18th July 2022. For analysis purposes, Nordic countries were grouped as one market (n=68). Health professionals were Emergency Department Physicians, General Surgeons, Internal Medicine Physicians, Critical Care Physicians or Pulmonologists and chose to take part in the survey. All physicians had been qualified for 3-30 years and spend the majority of their clinical time in a hospital, spent at least 50% of their professional time in direct patient care. The overall total results are based on country averages across the four regions, and each was weighted equally across the UK, France, Spain and the Nordic countries included.

References:

1. Rudd, K. et al. Global, regional, and national Sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. The Lancet. 2020; 295: 200-11. 
2. World Health Organisation. Cancer. Available at: https://www.who.int/health-topics/cancer#tab=tab_1. Last accessed: July 2022.
3. European Sepsis Alliance. What is Sepsis? – Definition of Sepsis. Available at:  https://www.europeansepsisalliance.org/sepsis#:~:text=Impact%20in%20Europe,%2C%20mental%2C%20and%20cognitive%20problems. Last accessed: July 2022.