Junior doctors are not good at recognising and treating sepsis: a validated suggestion for improvement

Background

Early recognition and treatment of sepsis is well recognised to reduce morbidity and mortality. Appropriate intervention with antibiotic agents and the potential involvement of intensive care specialists are key management elements.^1–3

Aims

The aims of this study were to ascertain:

• the level of knowledge among foundation year 1 (FY1) doctors of the criteria for diagnosing systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis, as well as their knowledge of basic initial management of septic patients

• whether a targeted brief intervention using an attachable laminated data card could improve FY1 knowledge.

Outcomes

There was a 100% response rate. Prior to giving out the cards only seven of the 26 doctors knew all four parameters for diagnosing SIRS, whereas after issuing the card 100% of the trainees knew the criteria. Nobody at first knew the necessary degree of abnormality in all the values that are required to diagnose SIRS, but after intervention over 80% of the doctors knew the actual values. Notably 70% of respondents initially thought that blood pressure was a parameter for diagnosing SIRS.

In response to the question ‘What are the six organ systems whose dysfunction may indicate severe sepsis?’ no participant could initially identify more than four. After the cards had been given out, more than 90% of respondents recognised all six.

Among other management questions, only one-third of FY1 doctors would have requested a lactate in a suspected septic patient, whereas following the brief intervention 23 of the 26 would have ordered one (Table 1).