Michelle Webb on the need to improve sepsis recognition and treatment

Over 100,000 people a year have an episode of sepsis at a cost of around 35,000 lives, more than bowel and breast cancer combined. Sepsis is the third highest cause of death in hospitals and one of the commonest causes of death in pregnancy.

As a result of advances in medicine we are living longer. However, the medicines that we are using more and more to treat cancer, arthritis, and to allow us to perform transplants are also reducing our patients’ ability to fight infection—thereby increasing the risk of sepsis. Over the past 10 years the incidence of sepsis has increased by 8-13%.

In 2009 the “Sepsis Bundles” was introduced. It included six key things that needed to be done within an hour of diagnosis to ensure patients had the best chance of survival. Studies looking at the effect of these when implemented fully suggested they reduced the risk of death by 10-50%. Whilst most doctors know the six components, the main problems are recognition of sepsis (whilst it can be barn door, it is often subtle and can be missed) and delivering care in a timely and reliable way given all the other competing demands. The College of Emergency Medicine audited A&E departments in 2013 and found that even the best performing trusts were only delivering intravenous antibiotics within one hour in 46% of cases.

Last year saw the publication of reports from the Ombudsman and the All party parliamentary group on sepsis and the issuing of an NHS England patient safety alert. This year national CQUINS for sepsis have been introduced around screening and delivery of antibiotics within an hour of arrival at hospital.

Once infection starts to cause blood pressure to fall, every hour’s delay in giving intravenous antibiotics results in a 7% increased chance of dying, so it is imperative that it is recognized and treated early. This means that improving recognition and delivery of sepsis care is not just a priority for secondary care, but also for the ambulance service, primary and community care.

For these reasons sepsis is one of the Kent Surrey Sussex Patient Safety Collaborative’s five clinical priority workstreams.

On 26 March we held our first workshop, with representation from community and mental health trusts, patient groups, the ambulance and prison service as well as secondary care from across Kent, Surrey and Sussex.

A sepsis survivor told her story, describing the impact it had had on her life, really driving home how necessary this work is. Both national and local innovative projects were also presented, inspiring and sparking discussion amongst those attending. We agreed that the first priorities included:

• A standard approach to screening across the region for sepsis.
• improving recording of severe sepsis such that individuals affected are more easily identified to allow for analysis of care delivered.
• improving the information and support given to sepsis survivors.

Nial Quiney and I will be jointly leading the sepsis work stream for the PSC. We are currently establishing a reference panel and are keen to have representation from across the healthcare sector and involvement of patients or affected families. The only essential criteria are a passion to improve care for people with sepsis and a willingness to roll up your shirt sleeves and get stuck in.

If you’d like to get involved please get in touch with us at psc@kssahsn.net or 0300 303 8660

Michelle Webb is sepsis joint clinical lead for Kent Surrey Sussex Patient Safety Collaborative and a consultant nephrologist at East Kent Hospitals University NHS Foundation Trust.

Competing interests: None declared.