Sepsis remains a significant health concern across Europe, affecting an estimated 3.4 million individuals annually. The incidence rates are on the rise, with in-hospital mortality reaching approximately 24%, making sepsis one of the leading causes of death in European hospitals. Most patients diagnosed with sepsis are identified upon hospital admission, with over 80% receiving initial assessment and treatment in emergency departments (EDs). This highlights the critical yet challenging role of EDs in managing sepsis effectively.

In response, the Surviving Sepsis Campaign (SSC) introduced sepsis bundles in 2004 to streamline treatment protocols. These bundles, designed to prioritize key resuscitation measures, have evolved over time—from a 6-hour completion window to a 3-hour window, and most recently, a 1-hour bundle in 2018. While emphasizing timely intervention, these changes have increased pressure on emergency medicine physicians, especially since many patients are not transferred immediately to intensive care units (ICUs). Consequently, ED staff often need to implement all elements of the sepsis bundle, including fluid administration, blood culture collection, antibiotic therapy, lactate measurement, and vasopressor use, sometimes extending to complex ICU-level care when transfers are delayed.

The European Society for Emergency Medicine (EUSEM) has expressed concerns about the feasibility of the 1-hour bundle, warning that strict time constraints could disrupt ED workflows. They advocate for focusing on evidence-based practices rather than rigid timing. Achieving timely treatment remains a challenge, particularly in elderly patients or those with nonspecific symptoms, and is compounded by overcrowded EDs with stretched resources. These factors contribute to variability in sepsis management across Europe.

Understanding how EDs implement sepsis protocols is crucial for identifying gaps and barriers. Such insights can support targeted training, resource allocation, and improved monitoring, ultimately enhancing sepsis care across European hospitals.

A recent survey ⁽¹⁾ conducted by EUSEM involved 402 EDs from 28 countries. Results showed that while most EDs (72.5%) had a sepsis protocol, fewer implemented regular monitoring or structured training. The majority found the 1-hour bundle challenging to execute, with only 55% completing all elements within the timeframe. Major barriers included high patient volumes, staffing shortages, and inconsistent sepsis definitions, which delayed recognition and treatment. Concerns about increased broad-spectrum antibiotic use following the bundle's implementation also emerged, underscoring the need for balanced antimicrobial stewardship.

Overall, the survey provides a benchmark for current practices and highlights areas for improvement, such as enhanced training, better monitoring systems, and adherence to evidence-based guidelines. Addressing these issues is essential for improving sepsis outcomes in European emergency departments.

 

(1) Current sepsis management practices in European emergency departments: the ISG-emergency department European Survey

Bolanaki, Myrto; Kurland, Lisa; Brabrand, Mikkel; Daniels, Ron; Govender, Kiren; Hanses, Frank; Innocenti, Francesca; Lassen, Annmarie; Martin-Loeches, Ignacio; Möckel, Martin;

European Journal of Emergency Medicine ():10.1097/MEJ.0000000000001255, July 11, 2025. | DOI: 10.1097/MEJ.0000000000001255 (https://journals.lww.com/euro-emergencymed/fulltext/9900/current_sepsis_management_practices_in_european.187.aspx)