Sepsis care is improving in NHS accident and emergency departments but treatment needs to be faster, according to a new audit.
It found an improvement in the proportion of patients receiving the best care for severe sepsis and septic shock, but warned that improvements were needed to make treatment available faster.
“Sepsis continues to be a leading cause of death in patients admitted to hospital as an emergency”
A report, published today by the Royal College of Emergency Medicine, details the audit of 13,129 adults presenting to 196 emergency departments. It was endorsed by the charity the Sepsis Trust.
The report stated that the overall mortality rate for patients admitted with severe sepsis was 35% – around five times higher than for ST elevation myocardial infarction and stroke.
It noted that severe sepsis was a “time sensitive condition”, with one study showing there was an 8% increase in mortality for every hour appropriate antibiotic administration was delayed.
The audit identified a steady improvement in the “Sepsis Six”, an initial resuscitation bundle designed to offer basic interventions within the first hour of arriving at an emergency department.
Previous research has suggested that the number needed to treat (NNT) with the bundle to prevent one death is 4.67.
This compares to an NNT of 42 for aspirin in major heart attack and 45-90 for PCI in ST elevation myocardial infarction, noted the college.
“You have the potential to save a life at a very regular interval”
However, despite seeing improvements in care, the report found standards were not yet being met by all A&Es.
For example, there had been a steady improvement in giving antibiotics “over the years”, but still 44% of patients received them within an hour of arrival, said the report.
In addition, it noted there had been a slight improvement in the giving of intravenous fluids, from 40% to 43% since the last audit in 2011-12.
The taking of blood cultures and the measurement of lactate in the first hour have both improved as well, up from 40% and 49% to 45% and 60%, respectively.
However, documentation of urine output measurement remained poor, at only 18%, stated the audit report.
Documentation of a full set of observations on arrival was currently at 69%, although the number was brought down significantly by including capillary blood glucose.
College president Dr Taj Hassan said he “strongly” recommended that all emergency physicians and A&E nursing staff read the audit report.
He also encouraged them to review and improve the way in which they supported their multi-disciplinary A&E Sepsis Team and sepsis lead.
“Sepsis continues to be a leading cause of death in patients admitted to hospital as an emergency,” he said. “It is vital, therefore, that staff in the emergency department are able to rapidly assess, recognise, risk stratify and treat such patients with proven evidence based therapy.”
“Studies have repeatedly shown the power of the Sepsis Six resuscitation bundle in improving patient care if delivered in a timely fashion,” said Dr Hassan.
“With a number needed to treat of as little as 4.67, you have the potential to save a life at a very regular interval,” he stated.
Dr Jeff Keep, sepsis lead at the RCEM, added: “More positively, almost all emergency departments have a sepsis lead, a sepsis protocol and provide sepsis education. This is a great achievement.”
Earlier this week, a study indicated that overcrowded emergency departments, symptomatic of the NHS, especially in winter, could lead to vital delays in patients receiving treatment for sepsis.
US researchers warned that patients with sepsis had delays approaching one hour in being given antibiotics when seen in emergency departments that were overcrowded.
A separate US study also highlighted that quicker completion of a three-hour sepsis treatment bundle and rapid administration of antibiotics were linked with lower risk of mortality in hospital.
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Meanwhile, critical care nurses in Kent say they are successfully using social media to share best practice and ideas, including when it comes to raising awareness of sepsis.
The nurse-led critical care outreach team, which works across three hospitals at East Kent Hospitals University NHS Foundation Trust, says using social media is a great way to get key messages across.
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- Early identification and treatment of sepsis