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Study confirms ‘faster is better’ when it comes to sepsis care

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More rapid hospital treatment of sepsis improves patient outcomes and gives support to mandatory protocols, suggests US research.

Quicker completion of a three-hour sepsis treatment bundle and rapid administration of antibiotics were associated with lower risk-adjusted in-hospital mortality, found researchers.

“We can finally say that faster is better when it comes to sepsis care”

Christopher Seymour

The findings come as increasing attention has begun to be given to sepsis in the UK, with nurses at trusts around the country introducing innovations and a charity campaigning hard on the issue.

The US team set out to test the impact of a protocol designed to quickly identify and treat sepsis, which was introduced across New York State and sparked controversy.

Its introduction followed the death of 12-year-old Rory Staunton from undiagnosed sepsis in 2012, but led to widespread debate among clinicians on whether such a step would have saved his life.

The University of Pittsburgh study covered nearly 50,000 patients from 149 New York hospitals and claims to be the first to offer scientific evidence that the so-called “Rory’s Regulations” work.

Rory’s Regulations require hospitals to follow protocols for early identification and treatment of sepsis, and submit data on compliance and outcomes.

The hospitals can tailor how they implement the protocols, but must include a blood culture to test for infection, measurement of blood lactate and administration of antibiotics within three hours of diagnosis – collectively known as the “three-hour bundle”.

The researchers found that 83% of the hospitals completed the bundle within the required three hours, overall averaging 1.3 hours for completion.

For every hour that it took clinicians to complete the bundle, the odds of the patient dying increased by 4%.

Lead study author Dr Christopher Seymour, a US expert in critical care and emergency medicine, said: “There is considerable controversy about how rapidly sepsis must be treated.

“Some question the benefit of rapid treatment with protocols, saying they can have unintended side effects and be a distraction in busy emergency departments,” he said.

“After reviewing the data, we can finally say that faster is better when it comes to sepsis care,” he added.

The study findings were announced yesterday at an American Thoracic Society conference in Washington D.C., while being simultaneously published in the New England Journal of Medicine.

UK nurses and other hospital staff should treat patients with life-threatening sepsis symptoms within one hour, according to the National Institute for Health and Care Excellence.

In a draft quality standard, expected to be finalised on August, NICE said patients should be assessed carefully for sepsis and when classed as high-risk, should be reviewed and treated within an hour.

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