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Clinical feedback tool helps hospital trust bring down sepsis rate

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One of England’s largest teaching hospitals has achieved a dramatic turnaround in the care of patients with life-threatening severe sepsis after developing a tool to hold individual clinicians to account for their care.

Clinicians at Nottingham University Hospitals Trust believe their work, covering more than 600 patients, could be adopted by other trusts and help save more lives and improve patient outcomes.

“If you make teams and individuals aware of their performance they will improve”

Mark Simmonds

They developed an individualised feedback and audit process that reports on a monthly basis to nurses, consultants and junior doctors about how they cared for specific patients. Their care is RAG rated and given a score on how well the team complied with guidelines for treating severe sepsis.

It was prompted by an initial assessment of the trust’s sepsis care in 2005, which showed the trust was just 15% compliant with the international guidelines launched that year.

The trust has subsequently seen compliance with guidelines shift to 80% earlier this year. At the same time its crude mortality for critical care sepsis has fallen from 42% to 28%, while its trust wide septicaemia mortality has fallen from 119 to 86 since 2009.

Dr Mark Simmonds, the trust’s acute and critical care medicine consultant and sepsis lead, said he believed the feedback had led to a change in practice by staff.

Monthly reports identified “who was seeing the patient and where, who was getting involved in their care and when key decisions were made”, he said.

“If you make teams and individuals aware of their performance they will improve,” he added. “Everyone thinks they are doing the best for their patients, but if they are not they will learn and improve from that far more than they will from a lecture or email.

“In recent times the vast majority of reports we now send out are telling people they did a great job,” he said. “People are just as interested in positive feedback as they are negative.”

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