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PAT I ENT DET E RIORATION


also increases NHS costs. From a clinical value perspective, if the deterioration of a patient isn’t acknowledged and treated with speed, their length of stay will increase and their care will, in all likelihood, need to be escalated to ICU. As an example, if a patient develops sepsis and needs to be moved to an intensive care bed, this treatment costs the NHS around £30,000. However, if the deterioration is spotted earlier, patients can be treated using the ‘Sepsis Six’ on a ward. Those healthcare professionals working and familiar with the acute sector


understand that respiratory rate is the single most important factor in detecting patient deterioration. Those recently trained may not be as familiar with its importance, but great progress has been made to highlight and raise awareness of this issue – these include initiatives and courses such as AIM and ALERT. However, more work needs to be done outside the acute care sector to reinforce the important RR message. Sometimes those that require treatment on an AMU (Acute Medical Unit) are referred by their GP. Currently, there isn’t a perfected track


Risk of repeat infections in COVID-19 survivors


New data suggest that 20% of COVID-19 survivors are at risk of sepsis within a year of being discharged – costing Government additional £1bn unless diagnosed early. The UK Sepsis Trust (UKST) estimates that close to 100,000 people are going to be discharged from hospital having had COVID-19 and, of these, 20% are likely to develop sepsis within the first 12 months. In partnership with the UK Sepsis Trust (UKST), the York Health Economics Consortium have calculated that for every patient who is diagnosed early there is a cash saving to the NHS of over £5,500, meaning that 20,000 sepsis patients could cost more than £1bn in patient care and benefits.


If 50% of these patients can be diagnosed early through a simple awareness campaign – similar to the ‘Just Ask: Could it be Sepsis?’ campaign already successfully conducted by the UKST – this will generate savings of over £50m in direct cash costs through treatment savings and £514m for Government when mortality benefits are included. It is estimated that the mortality rate from sepsis has been reduced by 33% since the previous campaign was launched five years ago, equating to circa 14,500 patients per annum.


The UKST has therefore launched a new ‘Blurred Lines’ health communications campaign to raise awareness of the relationship between COVID-19 and sepsis, and to offer patient support to those affected via their COVID-19 Recovery Response programme. The UKST called on 11 London’s health charity communications expertise to create striking and disruptive content for social media, progressing the ‘Just Ask’ creative. The UKST will also run press advertisements in multiple publications, both offline and online in social and programmatic, where free advertising is available. Dr. Ron Daniels, Founder and Director of the UK Sepsis Trust, said: “This shocking data serves to remind us of the enormity of the threat of infectious


disease to mankind. We urgently need all health professionals, as well as the general public, to be aware of the signs of sepsis and subsequently avoid adding to the magnitude of this pandemic. Failing to do so will apply even greater pressure on the NHS as they face traditional winter pressures and potentially a second wave of COVID-19.” “The UK Sepsis Trust has written, with the support of Rt Hon Jeremy Hunt, to Rt Hon Matt Hancock and Sir Simon Stevens to ask for investment in the ‘Blurred Lines’ awareness campaign – £1m investment could save hundreds of lives and £200m in treatment and benefits further down the line.” Nick Hex, associate director for the


NHS & Public Sector, said: “There is a substantial economic cost associated with sepsis, both in terms of direct costs to the health system and costs to the wider economy. Raising awareness of sepsis can lead to avoidance of some of these costs through earlier identification and treatment.”


Sepsis (also known as blood poisoning) is the immune system’s overreaction to an infection or injury. Normally the immune system fights infection but, sometimes, it attacks the body’s own organs and tissues. If not treated immediately, sepsis can result in organ failure and death. However, with early diagnosis it can be treated with antibiotics. In the UK alone, 245,000 people are affected by sepsis with at least 48,000 people losing their lives in sepsis-related illness every year. The recent ‘Global Burden of Disease Report’ estimated that sepsis affected a staggering 48.9 million people and claimed 11 million lives worldwide in 2017. Manifestations of sepsis and septic shock are frequently the final pathway for emerging infectious disease threats such as the COVID-19 pandemic and the recent Ebola outbreaks, contributing to an increase in the overall global burden of sepsis.


40 l WWW.CLINICALSERVICESJOURNAL.COM


and trigger system to clarify the severity of the patient’s illness from primary to secondary care. However, it is vital that the same system is used across all areas of the NHS, from community to hospital settings, using the National Early Warning Score or NEWS2. A challenge that faces the current NEWS2 system is that there is a lack of evidence surrounding its effectiveness in a primary care setting. This isn’t because the system is wrong in itself, there just aren’t many studies that have sufficiently evaluated the impact of a track and trigger system at a primary care level.


As we increasingly move towards community-led care, with more complex cases being managed within the community setting, and patients being discharged earlier due to pressures on the system, it becomes increasingly important that the mechanisms in the community mirror those used in hospitals. It would be logical to standardise systems, such as NEWS2, to enable and facilitate observation data to be shared. This is already happening with the ambulance service and in some GP surgeries, but to ensure that these processes are fully optimised across both primary and secondary care they need to be made a national standard.


If these standardised processes are then automated to link to a patient’s EPR (Electronic Patient Record) a dashboard can be used to efficiently observe and give an accurate reading of a patient’s state. This can be easily seen by on-call doctors or critical care teams, allowing for an at-a- glance overview of a patient’s condition, which in turn allows for the healthcare team to prioritise treatments and any necessary interventions. Finally, the automation and standardisation of observation data will also allow for the iteration of the NEWS2 process over time. If all patient data can be accumulated and mapped all the way to outcomes, we will have a far better understanding at a granular level, which areas of the observation process are working well, and which areas need improving. We may learn over time that an RR of 28 is more predictive than that of 25. However, we can only secure this insight and make strides and improvement in patient treatment through the standardisation of data collection. Mapping data across all care settings, both primary and secondary, will help improve patient outcomes. Global medical technology provider, Hillrom, and The UK Sepsis Trust, earlier this year, announced a year-long partnership to raise greater awareness of sepsis. Together they are working together to provide training to hospitals on how they can use existing technology to help identify deteriorating patients more quickly. By using a fully


SEPTEMBER 2020


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