Analysis

In the ten case stories described in this report, the shortcomings, compared with the applicable standards, are:

Standard	Number at variance
Timely history and examination on admission or referral.	6
Investigations to determine: Indices of perfusion Indices of infection Source of infection Cultures of blood and other sites.	7 5 4 6 5
Regular physiological monitoring using track and trigger systems.	3
Accurate recognition of severity of the illness.	7
Basic resuscitation with: Large-volume fluid therapy Intravenous broad-spectrum antibiotics after taking cultures Vasopressor therapy if required to maintain adequate haemodynamics and tissue perfusion.	8 7 7 5
All of these actions to commence immediately on recognition of severe sepsis and to be completed within six hours.	5
Source control to be performed as soon as possible after initial fluid resuscitation.	5

Standard	Number at variance
Adequate education and training of staff.	2
Appropriate and timely senior medical input.	6
Timely referral to critical care.	5
Formation and documentation of a management plan.	1
Handover according to protocol.	1
Appropriate and timely referral for source control.	1

Time to Act: Severe sepsis - rapid diagnosis and treatment saves lives