The ‘sepsis team’
‘We are all aware of the importance of early diagnosis and rapid appropriate treatment of patients with severe sepsis. Yet, many patients still do not receive satisfactory early management and the application of recent guidelines for sepsis management is still inadequate,’ writes Jean-Louis Vincent MD PhD, from the Intensive Care Department, Erasme Hospital, Université Libre de Bruxelles, Belgium.
‘One of the reasons for this deficiency is the complexity of patients with severe sepsis in whom appropriate management involves multiple components, from laboratory tests and cultures to hemodynamic monitoring to therapeutic interventions, all of which need to be performed as soon as possible after diagnosis to maximise chances of survival.
How should we approach our patients with severe sepsis or septic shock? How can we simultaneously and effectively perform all the necessary tests and treatments? Take blood and cultures, attach monitoring devices, insert intravenous/central/arterial lines, start antibiotics, arrange imaging and X-rays, ask for a surgical opinion or arrange for an operating room to be available, administer fluids, give vasopressors …? No matter how efficient we are as individual doctors, a single doctor or nurse simply cannot adequately manage a patient with severe sepsis within acceptable time delays.
Here, we can learn much from other fields of medicine. For example, severe trauma patients are now never (or very rarely) managed by single physicians, but rather by a team including, as a minimum several doctors and nurses, but which may also include anaesthesiologists, paramedics, radiographers, specialist surgeons, etc. Similarly, in-hospital patients who experience cardiorespiratory arrest will not be managed by one individual, but by a Crash or Code Team of personnel specially trained in resuscitation techniques and able to travel rapidly to the patient in need. Each member of the team has a specific role so that all aspects of management are covered. Importantly too, all necessary equipment is immediately available in a single mobile unit, the ‘Crash Cart’.
In the same way, patients with severe sepsis should be managed by a ‘Sepsis Team’ comprising several physicians and nurses, and also possibly an infectious diseases specialist, radiographer, phlebotomist, etc.
The Sepsis Team should be available 24/7 and responsible for stabilisation and early treatment of all patients with severe sepsis. Critically, one member of the team must be allocated as leader, to direct and drive ongoing management and ensure that all aspects of care are covered in the most efficient and effective way. Without a good Team Captain, the process risks becoming disorganised and chaotic with no clear instructions as to who should be doing what, when.
In our hospital, rather than a mobile sepsis team, we have a dedicated ‘shock lab’, which treats all patients in the hospital or emergency department who develop shock, including septic shock. This unit is staffed by a team of nurses and doctors trained in shock management and equipped with all the necessary monitoring devices, a respirator on ‘stand-by’ mode, and intravenous solutions and drugs ready to use.
Several studies have now demonstrated that sepsis teams can improve outcomes for patients with severe sepsis and we must encourage their development. By ensuring rapid initiation of all necessary treatments, specialised sepsis teams or units can effectively increase the chances of survival for patients with severe sepsis.
20.10.2011
