Sepsis

How was sepsis identified as an UCLPartners patient safety programme workstream?

In mid-2014 UCLPartners consulted its partner organisations through medical directors, nursing directors, executive forums and discussions with clinicians. Face-to-face consultation was supported by a formal survey. Sepsis and acute kidney injury were identified as priority areas for partners as well as being responsible for the greatest number of avoidable deaths (based on national data). These form the first two workstreams within the UCLPartners patient safety programme.

What is sepsis?

Sepsis is a syndrome representing an inflammatory response to an infectious process triggered by an infectious agent (bacterium, virus, fungus or parasite) which is severe enough to cause organ dysfunction. Sepsis affects all age groups and can present in any clinical area and health sector: over 70% of cases arise in the community.

A recent NHS England Patient Safety Alert estimated that 37,000 people die from sepsis in England per year, and that reliable delivery of care could save 11,000 lives a year – and £150 million annually.

A study of 170 UK critical care units found 21% of patients fulfilled the criteria for severe sepsis on admission, with an in-hospital mortality of 40.6% (Shahin et al, 2012).

Few organisations have regularly reported robust data about the numbers of patients with sepsis, the details of their treatments, and their outcomes.

What is the aim of the UCLPartners sepsis patient safety workstream?

The aim is to improve identification and treatment of sepsis across our participating trusts, thereby improving patient outcomes and care. In its initial stages the workstream will address the early secondary care sepsis pathway – focusing on quality improvement capability and patient safety leadership to create leaders of sepsis care in the region.

Who is the clinical lead?

John small

John Welch, Nurse Consultant in Critical Care, University College London Hospitals NHS Foundation Trust (UCLH)

John is a nurse consultant in critical care and outreach at UCLH, and clinical lead for the sepsis workstream in the UCLPartners patient safety programme. He also leads the UCLPartners reduction in cardiac arrests (deteriorating patient) workstream. He is a member of the NHS England Cross-System Sepsis Programme Board, the All Party Parliamentary Group on Sepsis Clinical Advisory Group, and the Royal College of Physician NHS Early Warning Score (NEWS) Development & Implementation Group. He has around 30 publications in the fields of acute and critical care. John is also working on two National Institute for Health Research (NIHR) funded research projects: a study of nurse-led psychological support for high-risk patients in ICU; and a study of cardiac arrests in over 100 hospitals. He is also a recipient and joint clinical lead of a Health Foundation Shine project grant.

Methodology

Our approach is based on the Breakthrough Series (BTS) Collaborative framework developed by The Institute for Healthcare Improvement (IHI). This is a specific, time-limited improvement methodology that has been deployed in around 1000 projects worldwide, designed to speed up the adoption of accepted best practice or evidence. This framework approach is summarised below. We held our third successful Learning Session on 1 July 2016. We are currently in Action Period 3, and we look forward to seeing you all at our Measurement day, on 21 September 2016.

Action period diagram

Which Trusts have expressed an interest?

We are delighted to have 12 trusts participating:

  • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Barts Health NHS Trust
  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • Homerton University Hospital NHS Foundation Trust
  • Luton and Dunstable University Hospital NHS Foundation Trust
  • Mid Essex Hospital Services NHS Trust
  • North Middlesex Hospital NHS Trust
  • Royal Free London NHS Foundation Trust
  • Southend University Hospital NHS Foundation Trust
  • University College London Hospitals NHS Foundation Trust
  • West Hertfordshire Hospitals NHS Trust
  • Whittington Health NHS Trust

Current activities and next steps

Trust teams are currently working on establishing and improving measurement, and trialling small tests of change. They are using PDSA cycles and the IHI Model of Improvement to improve processes within their Sepsis pathway.

We are meeting with trust teams during their patient safety operational meetings to support their local QI projects as well as to determine any other support they may require. We have commenced our lunchtime webinars and have created a collaborative zone to support trusts throughout the development of their QI projects. QI templates as well as the Collaborative Framework, change package and driver diagram can all be accessed and downloaded on our Collaborative Zone.

After 3 successful Learning Sessions, we are now in Action Period 3 and planning for a great End of Year Summit on Friday 2 December 2016.

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Feel free to contact a member of the team if you have any questions or feedback