Background Emergency departments (EDs) are often the first point of contact for patients with sepsis, and therefore play a critical role in early recognition and treatment. However, the extent to which sepsis guidelines are implemented across EDs in Europe remains unclear, and variability in adherence may impact patient outcomes. Objective This study aimed to assess current sepsis management practices in European EDs, evaluate adherence to international guidelines, and identify key challenges limiting effective implementation. Methods and design A structured survey was developed by sepsis experts from the European Society for Emergency Medicine (EUSEM). The questionnaire included both quantitative and open-ended items and underwent iterative refinement through pilot testing to ensure clarity and relevance. Settings and participants The survey was distributed to EUSEM members and national emergency medicine societies across Europe. Respondents included medical directors or designated sepsis specialists, with only one response requested per ED. Results A total of 402 EDs from 28 European countries participated in the survey. While most EDs (72.5%) reported having a sepsis protocol in place, less than half implemented regular monitoring or structured training measures. The 1-h sepsis bundle was described as moderately to highly challenging to implement by the majority of the respondents; just over half (55%) reported completing all its elements within 1 h of ED presentation. Key barriers included high patient volumes, insufficient staffing, and lack of standardized sepsis definitions, leading to delays in recognition and treatment. The results also highlighted concerns regarding increased broad-spectrum antibiotic use following the implementation of the 1-h bundle, emphasizing the need for a balanced approach that considers antimicrobial stewardship. Conclusion This survey establishes a benchmark for understanding sepsis management practices in European EDs, identifying substantial variations and challenges. Areas for improvement include enhanced training to follow protocols, improved monitoring systems that measure protocol adherence, and alignment with evidence-based guidelines.</p
