SEPSIS ALERT: Standardizing Sepsis Recognition in the Emergency Department

Sepsis is a time-critical medical emergency in which delayed recognition and initiation of treatment are associated with increased morbidity and mortality. As a high-volume tertiary referral centre, the Emergency Department manages both newly diagnosed sepsis patients and patients referred from other healthcare facilities with an established diagnosis. To accurately evaluate Emergency Department performance, the department initiated prospective monitoring of Emergency Department–identified sepsis patients, excluding referred patients with a pre-existing diagnosis. Baseline prospective monitoring identified opportunities to strengthen and standardize sepsis care through a structured multidisciplinary approach.

The key areas identified for improvement included:

• Standardizing physician-led sepsis identification using SOFA criteria.
• Improving multidisciplinary communication following sepsis recognition.
• Facilitating timely blood culture collection and early antibiotic administration.
• Enhancing resource preparedness for managing simultaneous sepsis alerts.
• Strengthening continuous monitoring of sepsis management practices and patient outcomes.

These findings formed the basis for developing and implementing the SEPSIS ALERT quality improvement program.

The project aimed to develop and implement a standardized multidisciplinary SEPSIS ALERT pathway for newly diagnosed sepsis patients in the Emergency Department.

The objectives were to:

• Standardize physician-led identification of sepsis using SOFA criteria.
• Establish rapid multidisciplinary communication following sepsis recognition.
• Improve compliance with evidence-based sepsis management.
• Improve timely blood culture collection and early antibiotic administration.
• Ensure adequate blood culture bottle availability within the Emergency Department.
• Prospectively evaluate patient characteristics, management practices, and clinical outcomes to support continuous quality improvement.

Prospective monitoring of Emergency Department–identified sepsis patients commenced in June 2025 to evaluate patient characteristics, management practices, and clinical outcomes. Baseline monitoring identified opportunities to strengthen sepsis care, following which the SEPSIS ALERT pathway was implemented in July 2025.

Emergency Physicians identified newly diagnosed sepsis patients using SOFA criteria. Following physician confirmation, a dedicated Sepsis Alert WhatsApp Group comprising Emergency Physicians, ER Nurses, and Medical Social Workers (MSW) was immediately activated to facilitate rapid multidisciplinary communication.

The coordinated response included blood culture collection before antibiotic administration whenever clinically feasible without delaying antibiotic initiation, early administration of appropriate empirical antibiotics, and continuous multidisciplinary monitoring.

To improve preparedness during simultaneous sepsis alerts, blood culture bottle availability within the Emergency Department was increased from 2 sets to 6 sets. Prospective monitoring continued until April 2026 to evaluate the impact of the initiative.

Implementation of the SEPSIS ALERT pathway resulted in measurable improvements in standardized sepsis management within the Emergency Department.

Baseline prospective monitoring demonstrated 78% compliance with evidence-based sepsis management. Following implementation of the SEPSIS ALERT pathway, prospective outcome evaluation demonstrated 96.1% compliance with the One-hour Sepsis Bundle.

Compliance with timely administration of empirical antibiotics and blood culture collection before antibiotic administration also improved through standardized physician-led sepsis recognition and rapid multidisciplinary communication.

A prospective observational study involving 129 Emergency Department–identified sepsis patients established institution-specific baseline data for continuous quality improvement. The study demonstrated a mean SOFA score of 5.2 ± 2.3, ICU admission rate of 70.5%, in-hospital mortality of 37.2%, and mean hospital stay of 8.22 days.

These findings provide a benchmark for ongoing monitoring, benchmarking, and future quality improvement initiatives.

Challenges

• Standardizing physician-led sepsis identification across all shifts.
• Ensuring timely multidisciplinary communication following sepsis recognition.
• Maintaining timely blood culture collection without delaying antibiotic administration.
• Ensuring adequate resource availability during simultaneous sepsis alerts.

Critical Success Factors

• Strong leadership from the Department of Emergency Medicine.
• Active participation of Emergency Physicians, ER Nurses, and Medical Social Workers.
• Standardized Sepsis Alert communication pathway.
• Increased blood culture bottle availability from 2 sets to 6 sets.
• Continuous audit, prospective monitoring, and regular feedback to the clinical team.

A structured multidisciplinary approach significantly improved coordination and standardization of sepsis management within the Emergency Department. Early physician-led recognition, combined with rapid communication and improved resource preparedness, enhanced compliance with evidence-based sepsis management.

Continuous prospective monitoring of Emergency Department–identified sepsis patients generated institution-specific data that supports benchmarking and ongoing quality improvement. The initiative demonstrated that meaningful improvements in patient safety can be achieved through workflow redesign, multidisciplinary collaboration, and continuous performance monitoring without requiring sophisticated technology.

The SEPSIS ALERT pathway is practical, sustainable, and readily replicable in similar Emergency Departments.