Impact of Sepsis Management Guideline Implementation in Emergency Departments: A Systematic Review of Process Measures and Clinical Outcomes.

Sepsis is a life-threatening condition associated with significant morbidity and mortality worldwide. The emergency department (ED) plays a crucial role in the early recognition and management of sepsis, as delays in treatment are strongly associated with worse outcomes. Although sepsis management guidelines and care bundles have been widely implemented to standardize and accelerate care, their impact on patient outcomes remains variably reported. This systematic review evaluated the effect of implementing sepsis management guidelines in EDs on both process indicators and clinical outcomes. A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library using a combination of controlled vocabulary and free-text terms related to sepsis, emergency care, and guideline implementation, yielding 4,309 records; after removal of duplicates and screening, eight studies met the inclusion criteria. Data extraction was performed using a standardized form capturing study characteristics, interventions, and outcomes, and risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The included studies comprised diverse designs, including before-and-after studies, retrospective cohort studies, observational studies, and one quasi-experimental trial. Overall, implementation of sepsis guidelines consistently improved process measures, including reduced time to antibiotic administration, increased lactate testing, improved blood culture collection, and higher compliance with sepsis bundles. However, effects on clinical outcomes were heterogeneous: some studies reported reductions in mortality, intensive care unit (ICU) admissions, and resource utilization, while others showed no significant mortality benefit despite improved process indicators. Additionally, some studies reported unintended consequences such as increased antimicrobial use and potential overtreatment. Most studies were judged to have a moderate to serious risk of bias, largely due to confounding and non-randomized designs. In conclusion, implementation of sepsis management guidelines in EDs is associated with consistent improvements in care processes and timeliness of treatment, but evidence for improved clinical outcomes, particularly mortality, remains inconsistent and is limited by study design and risk of bias; further high-quality studies are needed to establish causality, optimize implementation strategies, and balance timely treatment with antimicrobial stewardship.