Sepsis Challenges – the Sepsis Six

By Chris Hancock Programme Manager,

Rapid Response to Acute Illness Learning Set (RRAILS),

1000 Lives Improvement Service

After delivering a talk to a group of students, during which I had briefly mentioned sepsis, I was approached by one of the tutors. “I want to say thank you because now I think that I finally know what my mother died from” she said.

 She was a nurse tutor and therefore could be presumed to possess a reasonable knowledge of physiology and disease processes, yet had never heard of sepsis, this was no surprise.

Sepsis, is  the body’s reaction to infection which is responsible worldwide  for someone’s death every 3 seconds, sepisis is largely unknown to the UK public but, more worryingly, many healthcare professionals are ignorant of how to identify sepsis, the terrifying speed at which it progresses and the absolute necessity of rapid treatment.  

In the UK, sepsis is estimated to cause the deaths of 37,000 people annually, more than from any single cancer, at a cost to the NHS of £2.5 billion (1). As this figure is based upon Intensive Care data it is almost certainly an underestimate and does not take into account the burden of sepsis in primary and community care.

Although sepsis accounts for almost 50% of Intensive Care bed days it should not be seen as an ICU problem (3). We know that a significant proportion of the death and harm that is caused by sepsis could be avoided by enabling rapid identification, escalation and treatment in the acute ward or even pre hospital setting.

Terence Canning is one of the UK Sepsis Trustees who has moved back to Wales, following the death of his brother Mark from sepsis, to devote his time to raising awareness of sepsis.

One of Terence’s remarks has really stuck with me, he said “it’s not like cancer where you are searching for a cure, you know the cure, but you just need to make sure it’s done every time”.

What he was referring to was the ‘Sepsis Six’, the six simple actions, including administering antibiotics, which should be delivered within 1 hour of sepsis being recognised. A recent study has suggested that delivery of all elements of the sepsis six within the one hour limit was associated with a reduction of 50% in mortality (4).

In Wales sepsis has been declared a Tier 1 priority for the NHS. I am lucky enough to lead the Rapid Response to Acute Illness Learning Set (RRAILS) which has worked collaboratively with all Welsh Healthcare organisations, enable clinicians to improve the identification, escalation and treatment of sepsis and ultimately, of course, to reduce mortality.

This Twitterchat will promote discussion of subjects including:

  • Improving the speed of sepsis identification – EWS, screening tools
  • Communication and escalation – PSAG boards, safety briefings, SBAR tools
  • Effective treatment – Sepsis 6 bundles, sepsis response bags, standardised antibiotic formulary
  • Measurement – capturing process and outcomes data


  1. Daniels R. The incidence, mortality and economic burden of sepsis.  (2009) In: NHS Evidence emergency and urgent care.
  2. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. Feb; 34(2):344-53.
  3. Daniels, R. Nutbeam, T. McNamara, G. Galvin, C. 2011. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12


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