ASSESSING CLINICIAN'S KNOWLEDGE ON THE PRINCIPLES AND PRACTICE OF THE MANAGEMENT OF SEPSIS: A CROSS SECTIONAL ANALYSIS OF INTERNAL MEDICINE RESIDENTS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Sepsis continues to be the most expensive health care related problem in the United States and studies have shown that the rapid diagnosis and treatment of sepsis is crucial for appropriate management. The Surviving Sepsis campaign and the Sepsis 3 guidelines aims to equip physicians with the tools necessary for the early identification of sepsis and septic shock. Unfortunately, there have been known identified barriers in the successful implementation of these guidelines in daily clinical practice. One such barrier includes knowledge and familiarity with the Sepsis 3 guidelines. With this in mind, we aim to examine the knowledge and understanding of the Surviving Sepsis campaign and Sepsis 3 guidelines amongst the internal medicine residents in a community based academic internal medicine residency program. We believe that this will help identify potential gaps in knowledge, which, with continued didactic education, can improve patient outcomes, especially in the Intensive Care Unit. METHODS: A 13-part questionnaire was administered electronically over a 2-month period. The selection of respondents included the internal medicine resident staff and other specialties rotating through the internal medicine department. Anonymous responses were collected, with consent. Demographic data such as age, gender and year of training were collected. 9 questions examined the Surviving Sepsis campaign and the Sepsis 3 guidelines and recommendation which included topics such as fluid resuscitation, SOFA, qSOFA and the sepsis definitions. All responses were coded and tabulated into an electronic database for analysis. RESULTS: 58 persons responded to the questionnaire. The majority of persons (98.3%) were from the internal medicine department. The post graduate level of training was split between 22 PGY-1 (37.9%), 20 PGY-2 (34.5%) and 16 PGY-3 (27.6%). 35 persons (60.3%) answered “somewhat knowledgeable” in response to their level of comfort with the term sepsis, its treatment and associated complications; 14 persons (24.1%) responded "very knowledgeable", and 9 persons (15.5%) responded "not very knowledgeable". 56 persons (96.6%) responded correctly when asked about life threatening organ dysfunction being a dysregulated host response to infection in the Sepsis 3 guidelines. 48 persons (82.8%) responded with 30 ml/kg as the appropriate recommendation for fluid resuscitation. A question on the Surviving Sepsis campaign guidelines recommendation on the time for the administration of intravenous antibiotics resulted in a varied response with 33 persons (56.9%) responding with 60 minutes, 11 persons (19%) with 30 minutes, 10 persons (17.2%) with 90 minutes and 4 persons (6.9%) with 120 minutes. When asked to define septic shock, 48 persons (82.8%) responded with profound hypoperfusion as the component of sepsis while 10 persons (17.2%) responded with hypovolemia. CONCLUSIONS: Based on our study, knowledge gaps continue to exist amongst our internal medicine residents with respect to the Surviving Sepsis campaign and Sepsis 3 guidelines. This gives us invaluable insight and will allow us to recommend further didactic lectures to address these topics and implement institutional guidelines that will improve patient outcomes. CLINICAL IMPLICATIONS: With the identification of knowledge deficits, we hope to bridge the gap with the sepsis guideline implimentation which will result in improved patient outcomes. DISCLOSURES: No relevant relationships by Sai Achi, source=Web Response No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Janet Joseph, source=Web Response No relevant relationships by Richard Sheppard, source=Web Response