■ Safety of care:

Improving patient safety and reducing risks

Diagnostic delays in sepsis

A doctor walking down a hospital corridor

4 minutes

Published: August 2023

The information in this article was correct at the time of publishing

Note: This article was originally published in Hospital News.

“Sepsis is a leading cause of death worldwide,” says Jacqueline Fortier, Manager, Evidence Synthesis Unit at the Canadian Medical Protective Association (CMPA). “But diagnosing sepsis can be challenging, and this can lead to delays in treatment. This is what motivated CMPA’s new research paper.”

“We want to provide healthcare providers with practical tips for catching sepsis early on,” adds Fortier.

That new CMPA research paper – Diagnostic delays in sepsis: Lessons learned from a retrospective study of Canadian medico-legal claims, now available in the latest edition of Critical Care Explorations – highlights the diagnostic challenges of sepsis and offers advice to physicians, about the importance of communication and collaboration to curb delays in diagnosis.

With sepsis, prompt diagnosis matters

Sepsis occurs when the body’s severe response to infection results in organ dysfunction. In Canada alone, there are approximately 75,000 cases each year, resulting in over 16,000 deaths. Not every infection leads to sepsis, so it can be difficult to connect a patient’s early non-specific symptoms, such as fever, discomfort, and elevated heart rate, to an eventual progression towards sepsis. Delayed diagnoses can result in poorer outcomes and higher mortality rates.

The CMPA study focused on medico-legal cases (including regulatory College or hospital complaints and civil legal actions) resolved between 2011 and 2020. In general, the CMPA’s data reflects only the very small portion of cases where the complainant (e.g. a patient, healthcare professional, etc.) believes that the physician did not meet the standard of care. The CMPA’s goal is to analyze what went wrong, and use this knowledge to provide information to improve patient safety overall. Researchers identified 1,075 cases related to sepsis or relevant infections, of which 163 (15.2%) included peer expert criticism of the diagnostic process. Cases occurred in all types of care settings including family physicians’ offices, walk-in clinics, hospitals, and emergency departments, and most of the physicians involved were specialists in family medicine, emergency medicine, or surgery.

Lessons for physicians: Communication is key

A significant takeaway from these findings is the importance of clear communication between providers. In some cases, the physician may not have been notified about a patient’s deteriorating vital signs, or the physician may not have provided enough detail for nurses to understand what to do if the patient’s condition worsened. Working as a team to establish a culture of collaboration and collective situational awareness can mitigate these potential issues.

Communication with patients and their family members is also a key factor in addressing diagnostic delays in sepsis. Sepsis is an evolving process, and it can be difficult to determine when common infections like pneumonia, influenza, or streptococcus could become more serious and lead to sepsis.

“Physicians should ensure that the patient recognizes new or progressing symptoms,” says Dr. Gary Garber, Director of Safe Medical Care Research, CMPA. “When you send a patient home, make sure they know what constitutes a progressive symptom, and under what circumstances they should return for another assessment.”

The CMPA study also suggests that repeat visits to care providers may represent an early warning sign of sepsis. Nearly half of the patients in this analysis made multiple visits to their family physician, a walk-in clinic, or the emergency department in the lead-up to the development and diagnosis of sepsis. Some made as many as five visits. When a patient has sought care repeatedly, vigilance may be required in the re-assessment.

CMPA peer-reviewed research to help support patient safety

Peer reviewed research is conducted using CMPA data, the largest collection of physician medico-legal data in the world. The CMPA’s peer-reviewed research informs the development of evidence-based products and services to enhance the safety of patient care and reduce the risk of harmful events.

The CMPA website features published research and useful learning resources to assist physicians in improving patient safety, including Good Practices and eLearning modules. The CMPA also provides member physicians with medico-legal advice and assistance and compensates patients on behalf of members when it is proven the patient has been injured as a result of negligent medical care (fault in Québec).

“This sepsis analysis provides an opportunity to highlight areas where physicians and other healthcare providers can focus efforts for improvement,” says Garber. “We’re currently developing new resources based on this sepsis research, to help physicians reduce the risk of delayed recognition of sepsis and improve patient safety.”

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.