SEPSIS+ 2019 Using the tool


The SOS Insight Dashboard is an example of what can be achieved through cross- system collaboration. The dashboard has been created by Imperial College Health Partners (ICHP), through the Patient Safety Collaborative (PSC), with NHS Improvement’s Patient Safety Measurement Unit (PSMU) and NHS England all providing the unique breadth, to bring partners together and spark cross-boundary critical conversations. Dr Matt Inada-Kim, National Clinical Advisor, and colleagues in Oxford, conceived the SOS category in 2017. ICHP led on the concept, development and building of the dashboard, trialling it with clinicians as well as international figures in sepsis, Mervyn Singer (Professor of Intensive Care Medicine at University College London) and John Welch (President, International Society for Rapid Response Systems).


The dashboard also provides intelligence as to whether interventions and innovations in sepsis / infection care are improving outcomes for patients. It was launched in September 2018 by Celia Ingham Clark, NHS England’s medical director for clinical effectiveness, alongside Care Minister, Caroline Dinenage, at Imperial College Healthcare NHS Trust. Secretary of State for Health and Social Care, Matt Hancock, said of the dashboard: “Sepsis is a devastating condition that is notoriously tricky to diagnose, so I’m delighted to support this important new tool. Not only will it let clinicians understand the impact of different interventions for sepsis, but crucially, in the future it could help analyse which infections lead to sepsis more often. It is yet another example of how technology is improving patient care in the NHS.” Kenny Ajayi continued: “For the SOS Insights Dashboard to work, a collaborative approach has been taken, including input from doctors, coders, nurses and data analysts. Thanks to the success of this collaboration, 60 NHS Trusts are now using the dashboard.”


National Early Warning Score


Dr Alison Tavaré, GP primary care clinical lead at West of England Academic Health Science


The SOS Dashboard enables NHS staff to improve patient care and reduces potential harm by – for the first time ever – providing consistent, accurate and reliable data on sepsis outcomes.


Network, discussed the transition from NEWS to NEWS2 in the community. Alison is a front- line GP in Bristol, but also has a special interest in sepsis and was a member of the Sepsis NICE Guidelines Development Group. She is the primary care clinical lead at the West of England AHSN, raising awareness of sepsis and NEWS, and is now supporting the out of hospital change from NEWS to NEWS2. Alison and the team are also members of a West of England collaboration to identify innovative uses of NEWS, such as its place in a bundle of care to improve outcomes for people with learning disability. Her talk analysed an emerging West of England/ NHSE/LeDeR collaboration to develop a bundle of care to reduce the incidence and mortality from sepsis. Alison explained: “People with a learning


disability, on average, die 20-30 years younger than the general population, and sepsis is one of the most common causes. The use of NEWS2 can be used to improve the outcomes for this group, but what other multidisciplinary interventions can reduce the incidence of sepsis?”


“NEWS2 is the latest version of the National Early Warning Score (NEWS), first produced in 2012 and updated in December 2017, which advocates a system to standardise the assessment and response to acute illness.”


NEWS2 received formal endorsement from NHS England and NHS Improvement to become the early warning system for


identifying acutely ill patients – including those with sepsis – in hospitals in England. To support the safe adoption of NEWS2, NHS Improvement produced a resource pack.


How NEWS works The NEWS1


is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, already recorded in routine practice, when patients present to, or are being monitored in hospital. Six simple physiological parameters form the basis of the scoring system: l Respiration rate l Oxygen saturation l Systolic blood pressure l Pulse rate l Temperature l Level of consciousness or new confusion - the patient has new-onset confusion, disorientation and/or agitation, where previously their mental state was normal – this may be subtle. The patient may respond to questions coherently, but there is some confusion, disorientation and/or agitation. This would score 3 or 4 on the GCS (rather than the normal 5 for verbal response), and scores 3 on the NEWS system Temperature.


A score is allocated to each parameter as they are measured, with the magnitude of the score reflecting how extremely the parameter varies from the norm. The score is then aggregated and uplifted by two points for people requiring supplemental oxygen to maintain their recommended oxygen saturation. Alison explained: “This is a pragmatic approach, with a key emphasis on system- wide standardisation and the use of physiological parameters that are already routinely measured in NHS hospitals and in prehospital care, recorded on a standardised clinical chart – the NEWS2 chart. “We introduced NEWS across the area in 2015. Clinical judgement was critical, but the NEWS score made that job easier. Nurses feel empowered by using the NEWS scores to track deterioration and communication between clinicians has been markedly improved.”


Analytics and communication Kenny Ajayi Dr Ron Daniels 50 I WWW.CLINICALSERVICESJOURNAL.COM


Expanding on Kenny Ajayi’s talk, Kate Cheema, NHSI, provided a practical demonstration of the SOS Insights Dashboard. Kate has worked in a range of analytical roles throughout the NHS over the last 15 years. She is currently head of the patient safety measurement unit and is passionate about the effective use of data to effect and evidence change and improvement. By navigating through the dashboard, Kate clicked the tabs which provided both data and narrative for SOS, and sepsis activity from admissions and inpatient bed days, through to post discharge insights - both in terms of readmissions and survival. Katie Harrison, communication & engagement lead at Imperial College Health Partners (ICHP) provided a talk


SEPTEMBER 2019


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