AB178. SOH24AB_224. A closed-loop audit of adherence to the sepsis management guidelines among adult patients suspected of sepsis presenting to the emergency department at Cork University Hospital

Background: Sepsis is defined as a dysregulated immune response to infection, leading to life-threatening organ dysfunction. It is a common, time-sensitive medical emergency, where positive outcomes depend on early recognition and intervention. Surviving sepsis campaign has set out guidelines for the management of sepsis which includes the Sepsis 6 treatment bundle. We measured adherence to the Health Service Executive (HSE) Clinical Guideline No. 6: sepsis resuscitation and management bundle tasks (Sepsis 6) by way of a closed-loop audit.

Methods: Emergency department (ED) triage lists were prospectively screened daily, over a 7-day period, for patients meeting the criteria for Sepsis 6 deployment. Data pertaining to the completion of each Sepsis 6 task, physiological quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS), and the national early warning score (NEWS) data, and demographic data were collected. This was analysed, and the results were presented to the department staff. This audit cycle was repeated after a 7-month period in order to measure any change in adherence, hence closing the audit loop.

Results: A majority of patients (32%) received 3 out of 6 bundle tasks overall, and a mode of 2 tasks were completed within the recommended 1-hr. Lactate measurement was completed in 96% of cases, whereas urine output was completed in 36% cases. Completion of 6 total tasks increased by 150% between initial and re-audit cycles. There was an increase in completion of each individual task, with exception of oxygen therapy, between audit cycles.

Conclusions: The results illustrate an improvement in guideline adherence following a closed-loop audit cycle. This demonstrates the importance of continuous audit and QI in clinical practice.

Keywords: Audit; critical care; quality improvement; sepsis; treatment bundles