As a doctor in the Medical Receiving Unit at Wishaw General Hospital, I’ve seen first-hand the devastating impact sepsis can have, not only on the person who has sepsis but on their family and also on staff who are providing care. Sepsis is a life-threatening condition which arises when the body’s normal response to infection or injury overreacts and starts to harm organs and tissues. In the UK, it is estimated that there are 44,000 deaths from Sepsis each year. This is higher than deaths from heart attacks, and deaths from the three commonest cancers (lung, breast and colon) combined.
Over the last 10 years, the Scottish Patient Safety Programme (SPSP), has worked with NHS boards to reduce mortality and harm for people in a range of healthcare settings. In 2011, sepsis was identified as an important area for improvement that would support the aims of SPSP.
What we are doing
To do this, SPSP launched the Sepsis Collaborative in 2012 aiming to reduce deaths from sepsis by 10% by December 2014, by delivering earlier recognition and treatment for people with sepsis – this is important, as there is evidence that each hour’s delay in delivering antibiotics leads to the increasing likelihood of further harm and death.
“Over the last 10 years, the Scottish Patient Safety Programme (SPSP), has worked with NHS boards to reduce mortality and harm for people in a range of healthcare settings. In 2011, sepsis was identified as an important area for improvement that would support the aims of SPSP.”
Since the Sepsis Collaborative launched we have worked with clinical and improvement teams to:
- Improve the recognition of sepsis through implementation of the National Early Warning Score (NEWS). NEWS is an evidence based tool that assists staff to recognise sepsis early, this has now been implemented in 14 NHS boards and the Scottish Ambulance Service. The widespread implementation of NEWS is a critical step in improving communication in patient care.
- Improve the timely treatment for people with sepsis. Clinical teams have tested and implemented the Sepsis Six care bundle. Evidence tells us that reliable delivery of this care bundle can improve outcomes for people. Data shows that for patients identified as having sepsis across Scotland, antibiotic delivery within one hour increased during the Collaborative to around 80%.
- Improve awareness and communication of sepsis. Sepsis has become common terminology and is a standard item on ward and hospital safety briefs and regularly highlighted in visual prompts such as ward whiteboards.
- Improve education. We have developed the NEWS and Sepsis Screening App and an online training module for NEWS.
Since 2012, we’ve had fantastic engagement and support from NHS boards which has supported measurable benefits for patients:
- Mortality rates from sepsis has fallen by 21%,
- Hospital Standardised Mortality (HSMR) has fallen by 9.2% from August 2016, and
- The cardiac arrest rate in general ward setting has fallen by 27% across 16 reporting hospitals.
Working on sepsis has been a lever for us to drive better recognition and timely response to people who deteriorate from causes other than sepsis. Our approach of early recognition and response has helped support NHS boards to make sepsis, and other causes of deterioration, an issue that everyone working in healthcare understands and feels empowered to improve.
“We will continue to collaborate to maintain our focus on prevention, recognition and response to deterioration across the pathway of care. I consider it a privilege to be at the centre of this work where I can not only work closely with the national SPSP team, but also with front line staff to test new ways to continually improve the care we give.”
But sepsis is not just a problem in acute hospitals. Across a range of settings, SPSP has been able to spread this work and are now supporting improvements in Maternity and Children and Primary Care and the Scottish Ambulance Service. Standardised screening tools have been developed for use in Maternity and Paediatrics, and NEWS is being widely tested and implemented in Primary and Community care settings. Primary Care and ambulance crews have started to pre-alert hospital teams when Sepsis is suspected, leading to even faster recognition and treatment of sepsis.
Over the last decade, we have made great progress, which is a tribute to the hard work, resilience and openness to improvement of staff in NHS Scotland. But there are still plenty of opportunities to reduce harm for people in health and social care. We will continue to collaborate to maintain our focus on prevention, recognition and response to deterioration across the pathway of care. I consider it a privilege to be at the centre of this work where I can not only work closely with the national SPSP team, but also with front line staff to test new ways to continually improve the care we give.
Dr Calum McGregor is Clinical Lead for the Acute Care portfolio of the Scottish Patient Safety Programme (SPSP)