PATIENT SAFETY
‘Patients with severe sepsis have an associated mortality of between 20% and 30% and represent the population at greatest risk of unchecked deterioration in our hospitals.’
Recommendations The UK Sepsis Group believes that there is a need to look to care for other time- critical conditions to achieve major impact on sepsis mortality. Hospital-wide systems need further development, and the importance of sepsis raised on acute Trust risk registers.We need to learn to invest resources in measuring process and outcomes through simple sets of metrics in order to drive improvement. A national registry of patients who have suffered sepsis will help us to more fully understand the gaps in their care, and reporting of time to antibiotics (while this must not drive over-use of antibiotics) from identification of severe sepsis will help to focus minds as door-to-needle times for acute coronary syndrome do. For patients presenting with sepsis, a significant proportion of the total, seamless care must begin prior to the patient arriving in hospital.We are working with ambulance services, the College of Paramedics, and with GPs to design and test systems to reliably identify sepsis in the prehospital environment in order to facilitate communication with receiving units so that they may mobilise appropriate personnel. Health workers should start to explore
and discuss sepsis with colleagues and work out whether their own knowledge and systems are adequate, and whether an index of suspicion of sepsis is ingrained in a department’s culture. It is important to recognise that early identification, and the rapid administration of appropriate antibiotics and fluids, will achieve far more good for a patient than any degree of critical care support applied later. If we can nurture a health system
where just 80% of our patients receive optimal care using operational bundles such as the Sepsis Six, we estimate that 10,000 lives will be saved annually in the
‘It has been estimated in European studies that a typical episode of severe sepsis costs a healthcare
organisation approximately €25,000.’
48 THE CLINICAL SERVICES JOURNAL
international guideline-based performance improvement program targeting severe sepsis. Critical Care Medicine 2010; 38: 1–8.
11 Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H et al. Sepsis in European intensive care units: results of the SOAP study. Critical Care Medicine 2006; 34(2): 344-53.
12 Rivers E, Nguyen B, Havstad S et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. New England Journal of Medicine 2001; 345: 1368–77.
13 The Protocolized Care for Early Septic Shock (ProCESS) study.
https://crisma.upmc.com/ processtrial/
info2.asp
UK and cost benefits approximating £170 m per annum could be released to the NHS.
References 1 Bone RC, Balk RA, Cerra FB et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCMConsensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–55.
2 Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine 2003; 31: 1250–1256.
3 Davies A, Green C, Hutton J. Severe sepsis: a European estimate of the burden of disease in ICU. Intensive Care Medicine 2001; 27: S284.
4 Karlsson S, Varpula M, Ruokonen E et al. Incidence, treatment and outcome of severe sepsis in ICU-treated adults in Finland- the Finnsepsis Study. Intensive Care Medicine 2007; 33: 435-43.
5 Blanco J, Muriel-Bombin A, Sagredo V et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multi-centre study. Critical Care 2008; 12: R158.
6 The Intensive Care National Audit and Research Centre: Case Mix Programme Database (interrogated January 2006)
http://www.icnarc.org/DisplayContent.aspx? root=CMP
7 Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Critical Care 2005; 9(6):R764-70
8 Dellinger RP, Carlet JM, Masur H et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Critical Care Medicine 2004; 32: 858–73.
9 Dellinger RP, Levy MM, Carlet JM et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Special Article. Critical Care Medicine 2008; 36: 296–327.
10 Levy MM, Dellinger RP, Townsend SR et al. The Surviving Sepsis Campaign: results of an
14 Peake SL, Bailey M, Bellomo R et al. ARISE Investigators, for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Australasian resuscitation of sepsis evaluation (ARISE): a multi-centre, prospective, inception cohort study. Resuscitation 2009; 80: 811–8.
15 ProtocolisedManagement in Sepsis (ProMISe) Trial information.
https://www.icnarc.org/ CMS/
DisplayContent.aspx?root=RESEARCH
16 Kumar A, Roberts D,Wood KE et al. Duration of hypotension prior to initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34: 1589–96.
17 Gaieski DF, Mikkelsen ME, Band RA et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Critical Care Medicine 2010; 38: 1045–53.
18 Zavatti L, Barbieri E, Amateis E, et al. Modified EarlyWarning Score and identification of patients with severe sepsis. Critical Care 2010; 14 (Suppl 1): p254.
19 Daniels R, Nutbeam T, McNamara G et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emergency Medicine Journal 2011; 28(6): 507-12.
20 Robson WP, Daniels R. The Sepsis Six: helping patients to survive sepsis. British Journal of Nursing 2008; 17: 16–21.
About the author
Dr Ron Daniels is a consultant in critical care and anaesthesia at Heart of England NHS Foundation Trust. He is also chairman of the UK Surviving Sepsis Campaign. He is a member of Congress of the
Global Sepsis Alliance and sits on the ‘Global Sepsis as an Emergency’ committee. He is also a member of the of NHS Institute’s Safer Care Faculty and a Fellow of the NHS Improvement Faculty and is the founder and programme director of ‘Survive Sepsis’, from which the Sepsis Six treatment pathway originates.
MARCH 2012
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