• Helen Lindsay Cronshaw, Ron Daniels, Anthony Bleetman, Emma Joynes, and Mark Sheils.
• Emergency Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. hcronshaw@doctors.org.uk
• Emerg Med J. 2011 Aug 1;28(8):670-5.

BackgroundSevere sepsis/septic shock (SS/SS) has a high mortality. The past decade lays witness to a concerted international effort to tackle this problem through the Surviving Sepsis Campaign (SSC). However, bundle delivery remains problematic. In 2009, the College of Emergency Medicine (CEM) set out guidelines for the management of SS/SS. These set the standards for this audit.ObjectivesTo assess the recognition and management of patients presenting with SS/SS across three emergency departments (EDs) within the West Midlands.MethodsData were collected retrospectively over a 3-month period. Patients in the ED with a diagnostic code of, or presenting complaint suggestive of, sepsis, had their scanned notes assessed for evidence of SS/SS. Compliance with the CEM guidelines, and evidence of referral to the intensive care staff was evaluated.Results255 patients with SS/SS were identified. Of these, 17% (44/255) were documented as septic by ED staff. The CEM standard of care was received in 41% of those with a documented diagnosis of severe sepsis in the ED, and 23% of patients with SS/SS overall. 89% of patients received the 'treatment' aspects of care: oxygen, IV antibiotics and IV fluids. Twelve patients with a raised lactate level and normal blood pressure (cryptic shock) failed to receive fluid resuscitation. 71% of patients with SS/SS had no documented discussion or consideration of referral to the intensive care unit.ConclusionsThe SSC has had some impact; however, there is still a long way to go. It is assumed that the picture is similar in EDs across the UK and recommendations are made based on these local findings.

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