Management of severe sepsis and septic shock in the emergency department: current practice in the Netherlands

Introduction: Severe sepsis and septic shock may lead to organ failure and death. A substantial proportion (at least 25%) of sepsis cases are initially admitted to emergency departments (EDs). Several national and international initiatives have been developed to optimize sepsis recognition and early treatment to promote better outcome. We addressed aspects of current practice concerning sepsis in Dutch EDs. Methods: In early 2008 we conducted an observational study using questionnaires sent out to 107 medical directors of EDs in the Netherlands. These addressed Surviving Sepsis Campaign (SSC) awareness, aspects of clinical practice, guideline implementation and training programmes concerning sepsis. Results: The response rate was 61%. Awareness of SSC was low (51%). Sepsis identification criteria were available in 35% of EDs. Nurses and physicians were trained in the management of sepsis in 43-51% of EDs. On diagnosis of sepsis, lactate was measured in 83%, cultures are taken in 95% and antibiotics given in 85% of cases. Complete early goal-directed therapy was only applied or initiated in 22% of the responding departments. Conclusions: Sepsis presentation on admission to the emergency department is common. However, Dutch EDs seem to be insufficiently involved in the early recognition of sepsis and initial optimal treatment. There is room for improvement. Therefore, enhanced cooperation between health care professionals from EDs and ICUs is warranted to improve sepsis outcome.