BMJ Qual Improv Rep. 2016 Sep 19;5(1). doi: 10.1136/bmjquality.u210706.w4335. eCollection 2016.

Making the journey safe: recognising and responding to severe sepsis in accident and emergency.

BMJ quality improvement reports

Sarah Pinnington, Brigid Atterton, Sarah Ingleby

PMID: 27752314 PMCID: PMC5051421 DOI: 10.1136/bmjquality.u210706.w4335

Abstract

Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions.

References

1. Emerg Med J. 2011 Jun;28(6):507-12 - PubMed
2. N Engl J Med. 2015 Apr 23;372(17):1629-38 - PubMed
3. Am J Emerg Med. 2014 Nov;32(11):1319-25 - PubMed
4. N Engl J Med. 2014 May 1;370(18):1683-93 - PubMed
5. Support Care Cancer. 2015 Sep;23(9):2687-94 - PubMed
6. Intensive Care Med. 2000;26 Suppl 1:S64-74 - PubMed
7. Resuscitation. 2009 Jul;80(7):811-8 - PubMed
8. N Engl J Med. 2001 Nov 8;345(19):1368-77 - PubMed
9. Crit Care Med. 1992 Jun;20(6):724-6 - PubMed
10. JAMA. 2016 Feb 23;315(8):801-10 - PubMed
11. N Engl J Med. 2013 Aug 29;369(9):840-51 - PubMed
12. Clin Infect Dis. 2005 Nov 15;41 Suppl 7:S504-12 - PubMed
13. Crit Care Med. 2006 Jun;34(6):1589-96 - PubMed

Publication Types

• Journal Article