Speed up diagnosis of sepsis to avoid deaths, report urges

Delays in diagnosing sepsis are causing an upsurge in avoidable deaths, according to a new report that reveals vital signs of the condition are being missed in 60% of A&E patients.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reviewed the care of 551 adults admitted to critical care in more than 300 hospitals and GP surgeries across the UK who were later diagnosed with sepsis.

Among its key findings, the report showed:

  • One third (34%, or 184/544) of hospitals in the study had no formal sepsis protocol.
  • In 27% of hospitals with a sepsis protocol (86/314), there was no formal training on general wards in the use of the protocol for nursing staff.
  • Of the patients attending a GP surgery, only 26% (34/129) had their temperature taken and 31% (40/129) had their heart rate taken. Both can provide early signs of sepsis.
  • Sepsis, a condition in which the body overreacts to infection, kills more people each year than breast, bowel and prostate cancer combined. Of the 37,000 deaths each year, more than 12,000 are considered avoidable.
  • Early diagnosis is key, but NCEPOD revealed that even in the emergency department only 41% of patients had all their vital signs taken, and none of the reviewed GP notes detailed the early warning scores (EWS) system which should be used.
  • Being started on a care bundle (known as Sepsis Six, which includes oxygenation and antibiotics) following sepsis diagnosis is also shown to speed up recovery. However, it had been provided to only one third of patients (135/434) examined.

NCEPOD has now issued recommendations including that all hospitals adopt a formal sepsis protocol, to which every member of clinical staff has access and which is updated regularly, with compliance audited.

It also wants trusts to have a consultant review all acutely ill patients within the recommended national maximum of 14 hours after admission, to have formal arrangements in place for patient handover and to provide a 24/7 critical care outreach service.

East Kent Hospitals University NHS Foundation Trust acute care nurse consultant Tim Collins, who contributed to the report, said its recommendations can be easily implemented.

He said: ‘If 34% of the trusts examined can do it, then why can’t the rest?

‘Sepsis is now a leading cause of hospital-related deaths which can be misdiagnosed, so nurses provide a vital link in the task of identifying and treating it faster.

‘We need parity and a common purpose across the whole health network to ensure these standards are maintained for all.’

Frimley Park Hospital advanced nurse practitioner Suman Shrestha, who works in intensive care (ICU), said: ‘Sepsis prevention is resource-dependent as it takes time to train staff and audit. In the past, information has been a bit confusing, so all this might explain why protocols aren’t always in place.

‘Sepsis awareness training is mandatory on ICU but not on general wards, so it will be good to see this addressed, especially among healthcare assistants who often see patients first before anyone else.

‘We also need a safe ratio of nurses to patients, as sepsis is a very time-sensitive condition.’

The report has been welcomed by the UK Sepsis Trust. It can be downloaded from the NCEPOD website