Sepsis Awareness at the University Hospital Level: A Survey-Based Cross-Sectional Study

Background: Sepsis is a leading cause of morbidity and mortality. Prompt recognition and management are critical to improved outcomes. In 2019, the Lausanne University Hospital (LUH) launched a quality of care project aiming to improve sepsis management. As part of this effort, we aimed to assess sepsis awareness among nurses and physicians of the LUH and among the local paramedics. Methods: We conducted a survey on nurses and physicians at our institution and local paramedics between January and October 2020 representing over 1,000 professionals distributed over all hospital departments. The survey assessed professionals’ knowledge of sepsis epidemiology, definition, recognition and initial evaluation (nurses and paramedics) or sepsis epidemiology, diagnosis, and management (physicians). Pediatrics and the neonatal unit were excluded. Results: A total of 1,116 of 1,216 contacted persons among the 4417 targeted population participated and completed the survey (participation rate 91.8%). This included 619 of 2,463 (25.1%) of hospital nurses, 348 of 1,664 (20.9 %) of physicians and 149 of 290 (51.4%) of canton paramedics. Our nurse and physician sample was slightly imbalanced for sex and age. Thirteen percent of participants (28.4% of physicians, 5.9% of nurses, 6.8% of paramedics) correctly identified the Sepsis-3 consensus definition. Similarly, 48.6% of physicians and 10.0% of nurses identified the SOFA (sequential organ failure assessment) score as a sepsis defining score for infected patients. Furthermore, 24% of participants identified the Quick Sepsis-related Organ Failure Assessment (qSOFA) score as a predictor of increased mortality; 6% identified correctly the components of the score. For a patient with suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively identified blood cultures, broad-spectrum antibiotics and fluid resuscitation as required interventions; 76.4% and 18.2% of physicians requested these initial measures within 1 and 3 hours, respectively. For physicians, recent training correlated with awareness regarding definitions, SOFA score and qSOFA score use and components: ORs (95%CI) 2.2 (1.4-3.6), 4.3 (2.7-6.7), 3.4 (2.2-5.2), and 2.6 (1.5-4.6), respectively).Conclusions: We identify a deficit of awareness among physicians, nurses and paramedics at LUH correlating with a lack of sepsis-specific training. Enhanced sepsis-specific educational efforts could significantly improve early identification and treatment of affected patients.