Out of Hospital Sepsis Care
Diagnosing and responding to sepsis in an out-of-hospital environment is difficult but a failure to do so can be fatal to the patient.
The threat of sepsis
Sepsis is a fast-moving response to infection that can threaten the body's major organs and cause death within a few days. It is one of the main causes of death in the UK with approximately 44,000 people dying each year from it. Of these, it is thought that around 10,000 - 12,000 deaths may be avoidable.
Early identification
Clearly, therefore, the early recognition and treatment of sepsis is vital if the numbers of people dying from it are to be reduced.
It is widely recognised that this can be particularly tricky in out-of-hospital settings where approximately 70% of sepsis infections are believed to develop.
Problems in Out-of-Hospital Diagnosis and Care
A general problem with the diagnosis of sepsis in out-of-hospital settings is that infections are common and it is not necessarily easy to identify when the symptoms of an infection are developing into the symptoms of sepsis.
This difficulty is likely to affect not only GPs in their daily practice but a wide range of other health professional such as paramedics, community nurses, care workers and pharmacists.
A Scoping report by the Royal College of GPs in 2016 identified the need for increased awareness amongst GPs of the following elements:
- Rates of mortality
- Risk factors
- Signs and symptoms
- Urgency of hospital admission
- Diagnosis tools prevention
- Appropriate urgent responses
GP training in sepsis diagnosis
Furthermore, the 2017 Sepsis Summit Consensus Report published by the Royal College of GPs makes the following observations:
'Currently sepsis training and its frequency remains an individual decision for the GP and any employer. There is diversity of approaches to how patient assessment is taught and reflects the current plurality of views regarding the current NICE guidelines and the application of NEWS to the out-of-hospital environment. It was felt that there needed to be a consistency of message and approach across all Out-of-Hospital services and that the number and range of people accessing training needed to increase.'
NICE Sepsis Guidelines
In July 2016, the National Institute for Health and Care Excellence published new guidelines for the recognition and management of people suspected to be developing sepsis both in and out of hospital settings. It clarifies the symptoms likely to be observed and experienced in people within different age groups who are developing sepsis, elaborates on risk factors which clinicians should be aware of and specifies treatment routes and methods.
RCGP SepsisToolkit
Also in July 2016 The Royal College of GPs introduced an online Sepsis Toolkit which it describes as 'a collection of tools, knowledge and current guidance to support the identifying and appropriate management of patients with sepsis.' It is specifically aimed at GPs and healthcare professionals assessing people in the community with acute infection.
Their website includes a link to the Sepsis Trust Toolkit, developed in collaboration with the RCGP to provide pathways to diagnosis and response according to the circumstances and the individual affected.
Creating a common language
In addition to the implementation of consistent levels and frequency of training regarding sepsis, the need for a common method and language for the description and assessment of sepsis across different healthcare environments has also been identified as probably significant in achieving a faster sepsis response and more positive outcome for the patient.
The term 'suspicion of sepsis' has been proposed as a label for alerting concerns where specific clinical evidence may be missing such as an out-of-hospital setting. The RCGP report suggests that this could be supported with a 'NEW' score to clarify the patient's condition.
National Early Warning Score (NEWS)
NEWS offers a way of measuring and communicating the key signs of sepsis in a patient, helping to assess the severity of the patient's illness and the likelihood of mortality.
The NEWS assessment covers the following symptoms and signs:
- Respiration rate
- Oxygen saturation
- Temperature
- Blood pressure
- Heart rate
- Level of consciousness
It is suggested that the widespread and consistent use of common methods of description and assessment such as the above might reduce the numbers of people who needlessly die from sepsis.
Medical Negligence
Where the early symptoms of sepsis are not diagnosed, the patient can suffer with long-term significant physical and psychological effects. Where this is the case, the patient may be entitled to make a claim for compensation.
If you or a loved have suffered in this way, contact us to discuss your experience with a specialist medical negligence solicitor.
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