Factors affecting early treatment goals of sepsis patients presenting to the emergency department

Background and Objectives: Sepsis is a major cause of emergency medicine admission. It is associated with high mortality and morbidity. Even though sepsis is common in the Indian subcontinent, there is a paucity of data on the management of sepsis in India. The aim was to study the factors affecting early treatment goals. Methods: All clinically suspected sepsis patients consenting to be part of the study were included. The diagnosis of sepsis was made by the treating physician in the emergency department as per the Surviving Sepsis Guidelines criteria. All cases were managed as per institutional treatment protocol. The patients were prospectively followed up and the time taken to achieve the goal-directed sepsis bundle documented and analyzed. Results and Discussion: Of the 75 patients studied, the 3-hour(h) bundles were achieved in 70.7% of cases and 6-h bundles were achieved in 84% of cases. Meantime for obtaining blood culture was 107 min and administration of first dose antibiotics was 134 min. Thirty patients failed to achieve the early treatment goals, of which six were under-triaged, seven due to physicians delay in recognizing sepsis, 11 due to logistical delay, and six were due to financial constraints. Conclusion: The sepsis bundle goals were not achieved because of various factors such as under triaging, delay in diagnosis, logistical delay, and financial constraints. Further studies on whether sensitization of medical fraternity about sepsis, implementation of insurance policies for patient care or better point of care diagnostics would aid in achieving the bundles may be evaluated further.