Does application of the sepsis scoring system qSOFA and early notification to senior medical staff in a Remote Australian Emergency Department improve the outcomes of patients presenting with sepsis

Introduction of a 'code sepsis' at first presentation to ED triage at Alice Springs Emergency Department. A triage nurse trained and experienced in the use of the Australian Triage Score and qSOFA (quick sequential organ function assessment) will assess the likelihood of an infection being present and measure the parameters in qSOFA. If the patient has a clinical suspicion of infection and scores 1 or more on qSOFA a sepsis page will alert a medical officer. qSOFA is a bedside clinical score calculated using physiological parameters (blood pressure, respiratory rate) and clinical assessment of conscious level to provide a risk assessment of the likelihood of having or developing severe sepsis and septic shock. Block quasi-randomisation will be used on a week on week off basis with group one having clinical assessment (90% centile within 10minutes) and group two a clinical assessment (90% centile within 10minutes) and point of care lactate (serum blood test performed on analyser within the Emergency Department 90% centile within 10minutes from the time of triage). End points measured will be antibiotic rates, time to antibiotics and validation of the sensitivity of qSOFA with and without the addition of point of care lactate in a remote and mainly Indigenous ED population length of stay, rates and timing of ICU admission and mortality will be reported but this study is not expected to be powered sufficiently to detect a significant difference in these parameters Adherence to the protocol will be monitored and updates and education as well as recruitment figures supplied to triage and medical staff at weekly education meetings