Implementation of Surviving Sepsis Campaign Guidelines in a Tertiary Care Hospital and its Impact on Patient Outcomes: A Cross-sectional Study

Abstract

Introduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis care bundles, which incorporate key factors such as recognition, diagnosis, and early management, can help standardise the quality of care and have an impact on sepsis-related mortality rates. The Surviving Sepsis Campaign guidelines have formulated recommendations to be incorporated into sepsis care and management. Aim: To assess the compliance rate with the sepsis care bundle and study its impact on patient outcomes, specifically the mortality rate. Materials and Methods: This cross-sectional observational study was conducted at the AJ Institute of Hospital Administration in Dakshina Kannada, Karnataka, India, from October 2019 to December 2021. Adult patients in the Emergency Department with signs and symptoms of sepsis were diagnosed and categorised based on the Quick Sequential Organ Failure Assessment (qSOFA) tool. Patients with a qSOFA score >2 were further analysed using the SOFA score. The 2018 Surviving Sepsis care bundle was reviewed, and its utility in sepsis management was analysed. Empirical antibiotics to be administered to sepsis patients, in accordance with the hospital antibiogram, were shortlisted based on the category of sepsis at presentation. All sepsis patients were followed-up to track microbiological reports, appropriate escalation or de-escalation of antibiotics as per the hospital’s antibiotic policy, and the condition on discharge to assess patient outcomes. The impact on mortality rate was analysed using the Chi-square test, relative risk, and 95% confidence interval to compare mortality between the compliant and non-compliant groups. Results: A total of 156 participants took part in the study, of which 109 (69%) were male and 47 (31%) were female. The median age of the study participants was 59.6 years. Patient outcomes were measured using the mortality rate for different SOFA scores. A significant difference in mortality was noted between bundle adherent cases and non-adherent cases for SOFA scores 2. Conclusion: The sepsis care bundle helps standardise care and can reduce mortality in sepsis patients.

Keywords

• mortality
• quick sequential organ failure assessment
• sepsis care guidelines
• turnaround time