The principal concerns arising from our sepsis casework are initial assessment, initial treatment, delays and staff training. The NHS must address these issues as a ‘whole system’ to improve outcomes and reduce avoidable deaths.
1. Improving recognition
1.1 NICE will produce guidance to support GPs, ambulance staff and hospital clinicians to recognise severe sepsis in people at an early stage, so enabling earlier treatment which is known to improve outcomes. This should include the use of early warning scores, good practice in clinical assessment, best use of IT in managing available data, and new technology for near patient investigation (for example to measure blood lactate levels).
1.2 NHS England will prioritise a workstream on clinical deterioration including the early recognition of sepsis, and this may include helping providers of acute services to identify ways by which senior clinical staff are involved in patient management in a timely way.
1.3 The providers of acute services should identify ways by which senior clinical staff become involved early in the management of patients with severe sepsis.
1.4 NHS England will support the development of a public awareness campaign among vulnerable groups such as the immuno-compromised.
1.5 Education and training institutions should emphasise the importance of clinical staff listening to the relatives of patients as they can be the first to recognise the deterioration of the patient.
2. Improving treatment
2.1 NICE will include in guidance on sepsis the most clinical and cost effective management of people with severe sepsis, particularly in relation to the initial recognition and diagnosis of the condition and the timely use of antibiotics and fluid resuscitation.
2.2 Provider organisations should ensure full integration of available clinical guidance into their own clinical processes and systems to ensure timely treatment.
2.3 Provider organisations should foster attitudes and behaviours among their front‑line staff which values critical clinical thinking, the timely availability of senior decision makers, focused priorities, and the prompt implementation of clinical plans.
3. Continuous improvement
3.1 NICE will prepare a quality standard for the management of severe sepsis against which national audit should take place. The NHS should ensure appropriate data collection (examples of which should include times from arrival to commencement of fluid resuscitation and antibiotic administration, and the proportion of patients with infection screened for sepsis). This should be mandatory and linked to commissioning arrangements.
4.1 Clinical practice should be underpinned by robust information. Current research questions worthy of sponsorship include optimal fluid replacement; the development clinical tools highly predictive of severe sepsis applicable in primary care; development of near patient investigations applicable out-of-hospital and in emergency departments; and the reasons clinical guidance is not adhered to.
Our recommendations have been developed and agreed with the support and commitment of organisations who will be helping to implement them.
We believe that these actions will help to reduce the deaths and disabilities caused by sepsis.