Hundreds of lives saved through new technology to spot sepsis

The NHS has saved hundreds of people from sepsis thanks to better use of digital technology in hospitals | NHS England

In a major nationwide push to tackle sepsis, including a one hour identification and treatment ambition, new ‘alert and action’ technology is being introduced which uses algorithms to read patients’ vital signs and alert medics to worsening conditions that are a warning sign of sepsis.

Sepsis – also known as blood poisoning – is a life-threatening response to an infection in the body, where the immune system damages tissues and organs.

Three leading hospitals are using alerts to help identify sepsis and tell doctors when patients with the serious condition are getting worse..

NHS leaders in Cambridge, Liverpool and Berkshire are now helping the rest of the health service to adopt tools to spot it, which costs 37,000 lives a year and is notoriously difficult to identify.

In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year.

In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature.

In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.

Full story at NHS England

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Sepsis e-learning resource

Health Education England have launched an e-learning resource for executive, non-executive and management level staff in trusts on sepsis, incorporating antimicrobial resistance and stewardship.

The learning resource and training programme is designed specifically for boards and senior leaders. It introduces the NHS clinical priorities on these areas and explains how non-clinical leaders can help to improve how we approach sepsis and antimicrobial resistance.

123,000 cases of sepsis occur in England each year with approximately 37,000 deaths annually: this is more than breast, bowel and prostate cancers combined. Prompt recognition of sepsis and rapid intervention will help reduce the number of deaths occurring annually.

The learning materials that are available via this new resource support the early identification and management of sepsis and consists of the following five sessions:

  • Session 1 – Overview of Sepsis
  • Session 2 – Adult Sepsis
  • Session 3 – Childhood Sepsis
  • Session 4 – Complex Sepsis Issues and Future Development
  • Session 5 – Sepsis, Care Homes and the Frail Elderly

Further infomation and how to access the e-learning resource at Health Education England

NHS Long Term Plan to reduce toll of ‘hidden killer’ sepsis

Hospital staff urged to be more alert to ‘hidden killer’ sepsis | via NHS England

Hospital staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within an hour, as part of the NHS Long Term Plan to save thousands more lives. Every trust must take action to spot and treat the killer blood condition, which costs 37,000 lives a year, under guidance that is being mandated by NHS England.

The guidance, drawn up with the Royal College of Physicians, The Royal College of GPs, NICE and the UK Sepsis Trust, states that staff should look for sepsis at an early stage in patients coming to A&Es and those who are already on wards.

Medics must ask consultants for help if patients with suspected sepsis do not respond to treatment within an hour, and hospital teams should also take sufficient note of non-specific symptoms and concerns expressed by relatives and carers such as acute changes in behaviour.

Hospitals will be contractually obliged to ensure they fully comply with the guidance coming in from April.  The initiative comes as the NHS prepares to pilot new clinical standards aimed at providing swifter diagnosis and treatment for patients arriving at A&E with suspected sepsis.

Full story at NHS England

Related guidance: Sepsis guidance implementation advice for adults

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis A Systematic Review and Meta-analysis

Fang, F. et al| 2018| Association of Corticosteroid Treatment With Outcomes in Adult Patients With SepsisA Systematic Review and Meta-analysis|  JAMA Intern Med| Published online December 21, 2018|  doi:10.1001/jamainternmed.2018.5849

This systematic review with meta-analysis of 37 RCTs considers the research question: Are corticosteroids associated with a reduction in 28-day mortality in patients with sepsis? 

It reports in its study of over 9500 patients with sepsis, that the administration of arteriosclerosis was  associated with reduced 28-day mortality. Administration of corticosteroids were also linked to a increased shock reversal at day 7, as well as vasopressor-free days and with decreased intensive care unit length of stay. 

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The authors of the research suggest that administration of corticosteroid treatment in patients with sepsis is associated with significant improvement in health care outcomes and thus with reduced 28-day mortality.

Abstract

Importance  Although corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear.

Objective  To conduct a systematic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis.

Data Sources and Study Selection  MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until March 20, 2018, and updated on August 10, 2018. The terms corticosteroidssepsisseptic shockhydrocortisonecontrolled trials, and randomized controlled trialwere searched alone or in combination. Randomized clinical trials (RCTs) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis.

Data Extraction and Synthesis  Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data abstraction, and risk assessment.

Main Outcomes and Measures  Twenty-eight–day mortality.

Results  This meta-analysis included 37 RCTs (N = 9564 patients). Eleven trials were rated as low risk of bias. Corticosteroid use was associated with reduced 28-day mortality  and intensive care unit (ICU) mortality. Corticosteroids were significantly associated with increased shock reversal at day 7 and vasopressor-free days ( and with ICU length of stay, the sequential organ failure assessment score at day 7, and time to resolution of shock. However, corticosteroid use was associated with increased risk of hyperglycemia  and hypernatremia.

Conclusions and Relevance  The findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or standard supportive care. More research is needed to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

This article is available to Rotherham NHS staff through NHS Athens (one month embargo) or a paper copy of this article is available in the Library

Sepsis: Raising awareness

Sepsis is a serious complication triggered by an infection, and it can lead to multiple organ failure and death if not treated quickly.

Sepsis kills 44,000 people in the UK each year but many people have never heard of it. They certainly don’t know how to spot the signs and symptoms. We can all help prevent sepsis deaths if we’re aware of early symptoms in adults & older children and can get people treated immediately:

  • High temperature (fever) or low body temperature
  • Chills and shivering
  • Severe breathlessness
  • Confusion or slurred speech
  • Pale or mottled skin

In support their educational programmes to improve knowledge and management of sepsis, the UK Sepsis Trust and NHS England have developed ‘The Sepsis Game’ which helps health professionals learn how to spot and treat sepsis quickly and effectively.

The game is based around the Sepsis Six care bundle and supports the Survive Sepsis training programme. A simplified online version of the Sepsis Game  can be tried here.

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Image source: http://www.sepsisgame.com/

A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways

The aim of this study was to evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management | Infection Control & Hospital Epidemiology

All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations. Those not reviewed by an ID Fellow were considered controls and received standard sepsis pathway care. The primary outcome was antibiotic appropriateness 48 hours after sepsis trigger.

In total, 164 patients triggered the sepsis pathway: 6 patients were excluded (previous sepsis trigger); 158 patients were eligible; 106 had ID intervention; and 52 were control cases. Of these 158 patients, 91 (58%) had sepsis, and 15 of these 158 (9.5%) had severe sepsis. Initial antibiotic appropriateness, assessable in 152 of 158 patients, was appropriate in 80 (53%) of these 152 patients and inappropriate in 72 (47%) of these patients. In the intervention arm, 93% of ID Fellow recommendations were followed or partially followed, including 53% of cases in which antibiotics were de-escalated. ID Fellow intervention improved antibiotic appropriateness at 48 hours by 24% (adjusted risk ratio, 1.24; 95% confidence interval, 1.04–1.47; P=.035). The appropriateness agreement among 3 blinded ID staff opinions was 95%. Differences in intervention and control group mortality (13% vs 17%) and median length of stay (13 vs 17.5 days) were not statistically significant.

Sepsis overdiagnosis and delayed antibiotic optimization may reduce sepsis pathway effectiveness. Early ID AMS improved antibiotic management of non-ICU inpatients with suspected sepsis, predominantly by de-escalation.

Full reference: Burston, J. et al. (2017) A Role for Antimicrobial Stewardship in Clinical Sepsis Pathways: a Prospective Interventional Study. Infection Control & Hospital Epidemiology. Vol. 38 (Issue 9) pp. 1032-1038

Giving immediate antibiotics reduces deaths from sepsis

Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration. 

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This meta-analysis of observational data from 23,596 people in emergency department settings confirmed that giving antibiotics within one hour was linked to a lower risk of in-hospital mortality compared with giving antibiotics later.

This adds weight to recommendations from NICE and other organisations that antibiotics should be administered straight away in people with suspected sepsis. However, in practice up to a third of people in the UK do not receive antibiotics within the hour.

NHS England and the UK Sepsis Trust have recently launched a campaign to encourage all healthcare professionals to act quickly when they recognise sepsis.

Full reference: Johnston AN, Park J, Doi SA, et al. Effect of immediate administration of antibiotics in patients with sepsis in tertiary care: a systematic review and meta-analysis. Clinical Therapeutics.  2017;39(1):190-202.e6.