COMPLETING THE PICTURE
a decreased length of stay in hospital, and fewer intensive care days – findings that have since been replicated around the world. It consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis: l Titrate oxygen to a saturation target of 94% l Take blood cultures and consider source control
l Administer empiric intravenous antibiotics l Measure serial serum lactates l Start intravenous fluid resuscitation l Commence accurate urine output measurement.
The ‘Red Flag Sepsis’ concept is a questionnaire designed to quickly identify a possible case of sepsis. Pointers include: whether a patient responds only to a voice or pain – or is unresponsive; if they are in an acute confusional state; and if their heart rate is >130 per minute and respiratory rate is ≥ 25 per minute. If one of these ‘red flags’ are identified, then the Sepsis Six pathway is undertaken.
Both The Sepsis Six and Red Flag Sepsis are endorsed and recommended by the UK Royal Colleges and by NHS England. Dr Daniels’ organisation has been instrumental in driving national change, including the implementation of a national commissioning lever and reports from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), the All Party Parliamentary Group on Sepsis and the NHS Cross System Programme Board on Sepsis, together with the forthcoming NICE guideline. He recently developed a suite of educational materials and clinical toolkits in support of improvement, in collaboration with the Royal Colleges and NHS England.
Connected ECG diagnostics in a heartbeat
In 2017 Virginia Anderson, clinical physiology services manager, Northern Health and Social Care Trust, led a project to implement connected ECG devices that could bi-directionally communicate with the electronic patient record and provide efficiency savings to the Trust. Virginia provided an overview of the fundamentals of ECGs, together with insight into the clinical and technical requirements for a modern connected NHS cardiology department. Summarising how recording and storing ECGs contributes to the clinical management
Professor Daniel Clark, Nottingham University Hospitals NHS Trust
of patients, Virginia said: “There are many drivers for change. Traditionally, documentation of ECGs meant that an ECG was labelled with patient demographics – ie: number, hospital number, location, date, time and if the patient was symptomatic at the time of recording. These were left at the ward or clinic for inclusion in the patient chart. A referral was then manually put on CVIS by a cardiographer and the patient was booked into a clinic slot. “However, the administrative requirement is significant in the cardiographer role and not done by the few admin staff in the department. Secondly, as it was a manual process there was room for error – and no backup copy was retained. Finally, the ECG was only visible to those who had access to a patient chart.” Installing a Mortara ECG machine meant
that the Trust needed access to a server onto which an ELI Link could be uploaded and accessed remotely. ELI Link is a software application that runs on a designated server and provides the ability to convert Mortara ECGs into industry recognised formats – such as PDF, DICOM or XML. “The required server acts as a ‘gateway’
to the Trust’s Philips CVIS application,” said Virginia. “The ELI Link application does not store any ECGs on the server itself – its sole function is to take the Mortara ECG and convert it to a PDF format with a file structure that is recognised by the Philips application and export it to a designated shared folder.
There are at least 44,000 and likely nearer 80,000 deaths from sepsis every year in the UK, and around 40% of survivors of sepsis suffer at least one of a range of physical, cognitive and psychological sequalae. Chief Executive of the UK Sepsis Trust.
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“There are a broad range of benefits by using the new system. Minimal admin time is required – on completion of an ECG, the referral and appointment is automatically generated on CVIS. It also facilitates easier access to ECGs for quality control and audit purposes. Additionally, it has driven quality improvement and protects staff – if a patient is later to be identified as having an easier transmissible disease, such as TB, those staff who have had contact with the patient are easily identified from NIECR. “Finally, the ECG can be accessed from any PC by any NHS staff who have approved access, and duplicate ECGs are no longer required.”
Focusing on future technology
Afternoon sessions focused on future technology and how it can successfully be integrated within Trusts. Presentations were made by Dr Vaughan Michell, informatics lecturer and programme director at Henley Business School; Professor Daniel Clark, head of clinical engineering at Nottingham University Hospitals NHS Trust; and Timandra Harkness, science writer, broadcaster, and author of the book ‘Big Data: does size matter?’. Dr Vaughan Michell presented the research findings of a nine-month survey. The survey covered 20 examples of how Internet of Things (IoT) technology is currently being used in UK health services. The results were based on research and interviews with chief information officers, chief transformation officers, heads of informatics, clinical consultants and IoT health product suppliers.
IoT creates a better quality of life by connecting ‘things’, which can be patients and medical staff, objects, medical equipment and systems, and integrating them using web technology and connectivity. “The benefits of IoT are wide and varied,” said Dr Michell. “In terms of control and management, IoT provides the ability to present remote measurement data in real
SEPTEMBER 2018
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