24 November 2017

The value of multiprofessional networks in combating paediatric sepsis

This blog was written for UCLPartners by Dr Matthew Snowsill, Emergency Medicine Registrar

I must say what a result it was when my paediatric consultant (during a conversation about our hospital’s sepsis practice) said that she was attending the UCLPartners Paediatric Sepsis Network’s first session and had a spare ticket due to a colleague dropping out.

Whilst I don’t look like a Lucy and I am certainly not a skilled paediatric oncology nurse I was happy to deputise and we jumped on the train to head to Central London to attend. One quick name badge change and we were ready to get underway.

It quickly became apparent that I was the only emergency medicine registrar present which surprised me greatly. We see a huge number of children every day and the idea that I could miss an occult and genuine sepsis case is one that makes the hairs on the back of my neck stand up.

I think all emergency departments have those stories, the ones where there was nothing that seemed wrong but yet within a few hours everything had turned on its head and a child required emergent intervention.

That is why the idea of a network of professionals and patient advocates was such a powerful draw to me. To sit in a room with colleagues across multiple professional groups and specialities from the community, GP practices, district general hospitals, tertiary centres was a profound experience.

I was certainly daunted by the seniority of those around me but very quickly humbled by the honest and candid concerns and passions that they shared with the room. Seniority and experience only changes so much and after that the fight against sepsis needs evidence, systematic regional, national and international consensus, and the free sharing of ideas.

That is what we had.

The talks moved from Dr Deep’s (of UK Sepsis Trust fame) opening keynote to case studies examining different institution’s attempts to manage and mitigate the risk of their young and vulnerable patients slipping through the net.

Southampton’s screening tool and incredibly personal account of Helen Rutowska (a professional and mother who has seen both sides of paediatric sepsis) was a potent call to arms. The data they shared showed the value of starting a local initiative and sharing the successes with others.

Michael Carter then took us through the UCL pathway and stoked the discussion by raising questions and comments about the NICE guideline over-triaging patients and taking away both attention and resources from truly septic patients.

The absence of a clear definition for paediatric sepsis an in era of Sepsis-3 (Singer et al., 2016) and organ dysfunction-centric pathophysiology creates an enormous difficulty when having a conversation about methods, outcomes, strategies and anecdotes. Not only the lack of a modern definition but it was particularly resonant around the room that the absence of a standardised, national Paediatric Early Warning Score contributes to these great difficulties.

These feelings were again mirrored in the break out groups which dealt with proposed themes which were thought to be central to good quality care for children with suspected sepsis.

Throughout the day the most striking things were the passion demonstrated by the delegates but also how honest and candid their accounts were. There was no one-upmanship, no reluctance to share successes or failures and no ego obstructing the planning of the next session.

It was clear that all parties feel strongly that cooperation as a network will allow us to move forwards towards safer care for our patients and culminated in an agreement to crowd source our respective pathways, PEWS ranges and outcome data. Hopefully this will help the network to gain a consensus regarding whether there is room to improve on NICE’s excellent and timely work and standardise our approaches to the highest possible standards.

The next session is coming up on 5 December and I’ll be travelling with colleagues from paediatric HDU and paediatric oncology. Until then it’ll be great to look through the materials provided by our colleagues and see what great ideas are out there for our district general hospital to consider.

Our next event Paediatric sepsis: improving recognition and care II will be held on 5 December, 4.30-8pm. Register your place here

 

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