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-care 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 (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive 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 with hospitals without QIIs. A total of 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 regard 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.

Keywords: quality of care; sepsis management; sepsis programs; sepsis screening; standard of care.

Figure 1.

Participating countries and numbers of hospitals in the different regions sampled (see Table E5 for detailed information).

Figure 2.

Screening for sepsis in different regions: proportions of screening in emergency departments, on wards, and in ICUs. The blue bars show the proportions of screening in the different regions. The green line represents the level of screening in emergency departments, wards, and ICUs in all hospitals that have a quality improvement initiative (QII) on a regular basis. The 95% CIs of hospitals with QIIs are displayed as green dotted lines. The absolute differences between hospitals with QIIs and hospitals in each region are displayed in gray (see Figure 5).

Figure 3.

Standardized sepsis management in different regions: proportions of standardized sepsis management in emergency departments, on wards, and in ICUs. The brown bars show the proportions of standardized sepsis management in the different regions. The green line represents the level of standardized sepsis management in emergency departments, wards, and ICUs in all hospitals that have a quality improvement initiative (QII) on a regular basis. The 95% CIs of hospitals with QII are displayed as green dotted lines. The absolute differences between hospitals with QIIs and hospitals in each region are displayed in gray (see Figure 5).

Figure 4.

Quality improvement initiatives for sepsis in hospitals (n = 859).

Figure 5.

Implementation of screening and standardized management, antibiotic stewardship, and antimicrobial guidelines in hospitals with and without QIIs. The spider chart presents implementation of measures as proportions (percentages). ED = emergency department; QII = quality improvement initiative.