Queensland audit confirms under-recognition of sepsis

Thursday, May 18, 2023

The Queensland Sepsis Program continues to support improved clinical practice with another paper titled Recognition and Management of Hospital-Acquired Sepsis Among Older General Medical Inpatients: A Multi-Site Retrospective Study recently published in the International Journal of General Medicine. The paper has attracted more than a thousand views online.

The study, led by Professor Ian Scott, Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital (PAH) and Chair of the Queensland Clinical Network Executive and supported by members of the Queensland Sepsis Program (QSP), reviewed the recognition, management, and outcomes in a cohort of older adult general medical inpatients with probable or confirmed sepsis.

To obtain the study data, Dr Nicholas Barker, PAH, performed a retrospective audit of patients admitted across a two-year period who were coded as having an episode of hospital-acquired sepsis.

Professor Scott said the study findings further supported international research around the under-recognition of sepsis.

“Frail, older patients typically have multiple co-morbidities so their baseline observations, which can already be abnormal, can obscure early indications of sepsis. However, the lack of recognition may also be due to junior staff not having the experience to recognise or consider sepsis, confusion with other acute conditions which can cause clinical deterioration similar to sepsis, different sepsis identification strategies, and the competing priorities of a busy inpatient ward,” Professor Scott said. The authors also theorised concerns around excessive antimicrobial use might influence decision-making.

The article refers to other Australian studies which show how the use of a sepsis bundle in various states, including Queensland, has delivered improvements such as:

  • improved administration of intravenous antimicrobials within one hour of triage for sepsis and septic shock
  • increased rate of blood culture collection before antibiotic administration
  • increased collection of serum lactate
  • reduced requirement for ICU admission.
  • Professor Scott said an inpatient sepsis bundle such as the one being piloted in Queensland could improve sepsis recognition and management in frail, older patients.

    “We encourage senior clinicians who are capable of influencing care practices and senior nurses who may initiate sepsis screening strategies to consider our findings and implement the inpatient sepsis pathway once it’s ready for statewide rollout,” Prof. Scott said.

    Last updated: 18 May 2023