Table 2 Narrative Synthesis with description of factors influencing early initiation of fluid bolus in sepsis

Baldwin (2008) [30]

32

Near patient lactate testing

Underestimating the severity of sepsis; incomplete triage data hindering prompt diagnosis; first assessment done by very junior doctors.

53%

100% completion of triage vital signs; review by middle grade doctors within first 30 min; training nurses and doctors.

Kang (2012) [31]

317

Care by board-certified emergency physicians; nurses with > 3 yrs. experience

Patients with cryptic shock, higher serum lactate levels or without hyperthermia; care by junior resident doctors

256 (80.8%)

Overcrowding; sex- based differences of the treating physician

Interventions focussing on the identified barriers

Shin (2012)

770

ED overcrowding

81.9%

Multidisciplinary response team; effective bed management

Gray (2013) [32]

626

Difficulty recognising sepsis; clinical reliance on development of hypotension

48%

Pre-hospital sepsis screening criteria

Wang (2013) [33]

195

Survey response to why IV fluid challenge was not achieved: 41% unsure; 59% didn’t think it was needed. Knowledge, attitude and behavioural barriers.

27% (Control group)

Faine (2015) [34]

193

Interhospital transfers from regional hospitals; inadequacy of emergency trained physicians in rural hospitals; clinical deterioration of patient during transfer.

54% (Patients transferred from regional hospitals)

Use of telemedicine

De Groot (2017) [35]

1732

Treatment commenced in ED patients in earlier stages of sepsis

Emphasis on treatment in patients with and without organ failure in sepsis

Gaieski (2017) [36]

2913

Time of presentation of patients to ED (between 07:00–19:00 less likely to receive fluids within 1 h compared to presenting after-hours); overcrowding, increased occupancy rate and patient hours in ED

Appropriate staffing and patient flow in ED

Morr (2017) [37]

487

Correctness of exact classification of sepsis- SIRS, severe sepsis, recognised or unrecognised sepsis

Le Conte (2017) [38]

130

Advanced age; cardiac co-morbidities; delay in sepsis recognition; ED overcrowding;

25 (19%) received fluid challenge, Mean time to administration:

10 ± 27 min

Multidisciplinary quality improvement programme with simple guidelines, electronic alerts; qSOFA score measurement

Deis (2018) [39]

5631

Patients without an ICD sepsis diagnosis code despite similar baseline organ dysfunction

10.6% for patients without a sepsis diagnosis code; 19.6% for patients with a diagnosis code

Education and quality improvement outcomes