Interventions to improve early recognition and management of sepsis in emergency departments: A systematic review and meta-analysis.

OBJECTIVES: Timely recognition and management of sepsis in emergency departments (ED) is critical to improving patient outcomes. We conducted a systematic review and meta-analysis to evaluate the impact of targeted interventions on sepsis care in ED. METHODS: Studies published between 2001 and 2024 were included if they assessed interventions to improve sepsis recognition and/or management. Risk of bias was assessed using the ROBINS-I quality appraisal tools by Cochrane. Our primary outcome was the posterior probability of any intervention effect, using a Bayesian approach. Outcomes of interest included rates of compliance with sepsis guidelines, patient mortality, and time to administration of intravenous antibiotics and fluids. Both frequentist and Bayesian meta-analyses were performed, and heterogeneity was assessed using the I2 statistic. RESULTS: Fifty-six studies were included; all were before-and-after designs, except a single randomised controlled trial. Bayesian analyses estimated a posterior probability >99% of any improvement in compliance, and a posterior probability of 97% of any mortality reduction, in the context of sceptical priors, for targeted sepsis interventions. Pooled random-effects showed higher compliance during intervention periods (Risk Ratios(RR) =1.71, 95% Confidence Intervals(CI) 1.39-2.15; I2 = 93%) and lower mortality (RR =0.80, 95% CI 0.73-0.86; I2 = 46%), when compared to non-intervention periods. Time to treatment was also estimated to be reduced for antibiotics administration (Mean Difference (MD) = -32.5 min, 95% CI -44.7 to -20.2) and fluid administration (MD = -20.4 min, 95% CI -37.6 to -3.1). Posterior probabilities suggested a 90% likelihood of any time reduction, though estimates of reduced antibiotic times were sensitive to analysis that accounted for risk-of-bias assumptions. CONCLUSIONS AND IMPLICATIONS TO CLINICAL PRACTICE: Targeted ED interventions improve compliance with sepsis guidelines and reduce mortality. While gains in treatment timeliness were modest, likely reflecting prioritisation of sicker patients, evidence supports multimodal, context-specific strategies strengthening early sepsis management. Given heterogeneity of studies, future research should evaluate specific intervention components in well-designed, adequately powered randomised controlled trials. REGISTRATION: PROSPERO ID: CRD42024560232.