Discordance and similarities in provider experience and delivered care for patients with sepsis at a Hospital in Western Kenya

Abstract

RATIONALE: A qualitative assessment describing providers’ perceptions of care for patients with sepsis at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, was completed in 2023 (manuscript submitted for publication). This quantitative assessment was performed as a follow-up to corroborate qualitative results.METHODS: We reviewed the medical records of 142 patients diagnosed with sepsis at MTRH between 2022 and 2024. This retrospective chart review focused on laboratory investigations and empiric treatments initiated for patients with presumed sepsis and septic shock. Two Internal Medicine registrars from Moi University School of Medicine, both with extensive chart review experience, completed the review.RESULTS: Results from this quantitative study did not completely agree with qualitative results gathered previously and reported in a manuscript submitted for publication. While qualitative data suggests that blood cultures are routinely checked on admission, our quantitative data showed admission blood cultures documented for only 7.8% of patients. Similarly, although providers reported routinely checking Creactive protein (CRP) and procalcitonin (PCT) for sepsis monitoring, only 46.1% and 9.9% of patients had each of these lab values recorded respectively. Although the Surviving Sepsis Guidelines recommend serial serum lactate measurements for resuscitation monitoring, providers at MTRH reported infrequent use of the lab as it is only available on a blood gas analysis (BGA). This finding was consistent with quantitative data, as only 8.5% of patients had a serum lactate measurement documented with initial workup. Our results also show regular use of ceftriaxone as empiric therapy for sepsis (given in 78.8%) of patients, and de-escalation from broad spectrum antibiotics in 33.3%.CONCLUSIONS: These findings highlight the need for further investigation into barriers and facilitators affecting sepsis care at MTRH. For example, while providers understand the importance of early blood cultures and report efforts to obtain them, fewer than 10% of patient chars included a documented blood culture result. This discrepancy suggests potential system-level barriers. Process mapping the workflow- from ordering blood cultures, to sample collection, processing in the microbiology lab, and timely reporting to the clinical team- could help identify specific obstacles and possible solutions. Applying a similar approach to other aspects of sepsis care may help to standardize practice and make locally relevant guideline adherence more feasible.