A new study into the diagnosis and management of sepsis highlights that much needs to be done to improve patient care. The report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) confirms wide variability in the clinical presentation of sepsis and in its management in different healthcare settings.
The report estimates that 37,000 patients die with sepsis in the UK each year. Another 65,000 people survive episodes of severe sepsis, often with profound long-term complications that can include amputation and irreversible organ damage or neurological insult. It is a major cause of avoidable deaths and injuries. It is notable that the difficulty in defining sepsis may well mean that cases are under-recorded.
Sepsis develops when the body's response to an infection overwhelms the immune system. This leads to physiological changes such as raised temperature, respiratory rate and pulse. If left untreated, deterioration affects organ function and can be fatal. It is therefore vital to detect sepsis and begin treatment as soon as possible.
Given sepsis occurs as a response to infection, most cases are believed to develop in the community, with around a quarter occurring in patients who are already in hospital. The role of primary care is therefore key but the study also concludes that there must be more prompt recognition of the signs of sepsis in hospital care. Of the cases reviewed, only 36.5% of patients received good clinical practice.
The report's authors recommend that all hospitals need a formal protocol to identify and treat patients with sepsis at an early stage. They highlight that better awareness among clinicians is imperative. GPs and hospitals should adopt an early warning system for reviewing acutely ill patients against relevant factors wherever sepsis is suspected. There should be proper safeguards to move these patients from primary to secondary care. In hospitals, a full set of vital sign observations should be taken and recorded.
Proper and timely use of antibiotics is essential and senior microbiology input should be available 24/7. Acutely ill patients should be seen by a consultant within a maximum of 14 hours after admission and there should be formal arrangements for the handover of patients from A&E to receiving teams.
Many of the recommendations seem to be common sense but the underlying statistics indicate that there is a lack of adequate awareness among clinicians to be alert to sepsis and its early treatment in many trusts. Raising awareness and standardisation of management of sepsis are vital if patient outcomes are to improve.