Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey

Abstract

RATIONALE: Early detection, standardized therapy, adequate infrastructure and strategies for quality improvement should constitute essential components of every hospital's sepsis plan.OBJECTIVES: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute hospitals.METHODS: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives in hospitals.MEASUREMENTS AND MAIN RESULTS: 1023 hospitals in 69 countries were included. Most of them, 835 (81.6%) were from Europe. Sepsis screening was used in 54.2% of emergency departments(EDs), 47.9% of wards, and 61.7% of intensive care units(ICUs). Sepsis management was standardized in 57.3% of EDs, 45.2% of wards and in 70.7% of ICUs. The implementation of comprehensive quality improvement initiatives(QIIs) was associated with increased screening (EDs +33.3%; wards +44.4%; ICUs +23.8% absolute difference) and increased standardized sepsis management (EDs +33.6%; wards +40.0%; ICUs: +17.7% absolute difference) compared to hospitals without QIIs. 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs.CONCLUSIONS: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regards to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.