Audit of the ward-based management of severe sepsis in a large teaching hospital

Are adequate fluid challenges prescribed for severe sepsis?

PURPOSE

Managing severe sepsis early has several benefits. Correct early management includes delivering an appropriate fluid challenge. The purpose of this paper is to assess whether junior doctors prescribe adequate fluid challenges to severely septic patients.

DESIGN/METHODOLOGY/APPROACH

A questionnaire outlining three scenarios, each involving a patient with severe sepsis, but with varying weights (50/75/100 kg), was distributed to junior doctors, working in two UK hospitals, managing surgical patients. Participants were asked the fluid volume challenge that they would prescribe for each patient. Responses were compared with the Surviving Sepsis Campaign's recommended volume during the study (20 ml/kg).

FINDINGS

Totally, 77 questionnaires were completed. There were 15/231 (6.5 per cent) correct responses. The median volume chosen in each scenario was 500 ml, equating to 5-10 ml/kg. There was no significant difference between doctor grades (FY1 and SHO) in any scenario. With most junior doctors (FY1), there was no difference in responses according to weight; for SHOs the only significant difference was between the 75 and 100 kg scenarios.

PRACTICAL IMPLICATIONS

Junior doctors are not following guidelines when prescribing fluid challenges to severely septic patients, giving too little and not adjusting volume according to body weight. This implies that high-prevalence, high-mortality conditions are not being treated appropriately by those most likely to treat these patients. More teaching, training and reassessment is required to improve care.

ORIGINALITY/VALUE

This, the first case-based survey the authors could find, highlights an issue requiring significant improvement. The implications are likely to be relevant to clinicians in all UK hospitals.