Taking on a silent killer: A system approach

Sepsis is a leading cause of death in the UK. In 2014 it was estimated that there were 123,000 cases of sepsis in England resulting in nearly 37,000 deaths. It is estimated that by the application of best practice to all these cases as many as 10,000 deaths may be avoided each year. We know that when someone develops sepsis their deterioration can be quick and initially difficult to recognise. Mortality from septic shock increases rapidly for each hour that resuscitation and antibiotics are delayed. This has led to the development of hospital systems such as the “Sepsis Six Bundle” to ensure prompt delivery of key elements of treatment.

2017 Sepsis Six Bundle

  1. Administer Oxygen
  2. Take blood cultures
  3. Give IV antibiotics
  4. Give IV fluids
  5. Check serial lactates
  6. Measure urine output

All acute hospitals now have systems to detect and respond to suspected sepsis cases, which has been encouraged and supported by the development of a Sepsis Commissioning for Quality & Innovation (CQUIN) indicator in 2015. Successful as this has been, there is still scope for improvement.

Approximately 70 per cent of sepsis cases arise in the community which means that the opportunity for early identification and prompt management is as much a community problem as it is a hospital one. This requires the whole system to work well together to ensure that deteriorating patients are rapidly and appropriately assessed and that when suspected of having sepsis that they receive appropriate care.

NHS RightCare, working with the NHS England-led Cross-system Sepsis Programme Board, has developed this scenario comparing a difficult scenario against an ideal pathway. At each stage the impact on quality of life and costs are measured. It is intended that the scenario helps local health economies understand the implications on quality of life and costs – of shifting the sepsis pathway away from a suboptimal journey to one that consistently delivers timely evidence-based excellence.

Commissioners, clinicians and providers responsible for their population should consider:

  • Planning care models to address speedy diagnosis of possible sepsis in all areas of the health economy (Primary, Community and Secondary care)
  • Systematic and robust monitoring of patients for signs of acute deterioration using NEWS (the national early warning score version 2) and assessing acutely ill patients for sepsis
  • Providing tailored and speedy care to patients in line with guidance, which considers, for example, treatment burden and sharing information with other professions and services.
  • Education for clinicians, patients, carers and family members through a variety of appropriate communication channels.