Sepsis: How good are hospitals at treating ‘hidden killer’?

“The BBC, though not a bona fide medical research organisation, has a healthy, interrogative curiosity about health services.  Within this spirit of public concern, it reports knowledgeable opinion this week that patients’ lives are being placed at risk through delays in treating sepsis. 

Sepsis is a clinical syndrome in which patients have an overwhelming bloodstream infection (septicaemia) that is accompanied by an extreme systemic immune response causing major organ dysfunction.  Prompt identification and intravenous antibiotic infusion is crucial failing which, the condition proceeds to low blood pressure, abnormalities in cellular metabolism multiple organ failure and subsequent death. 

Citing an All Part Parliamentary Group Report (APPG) that is published by the UK Sepsis Trust (UKST), the BBC article warns of disquieting hospital delays in treating sepsis saying while intravenous fluids and antibiotics are indicated within one hour of diagnosis, and that, ‘a quarter of patients in England wait longer’. 

In its further observations, UKST said the criticality of one-hour treatment window is, ‘essential to increase the chances of surviving’ and furthermore, ‘there is no reason really why it should take longer’.  The APPG analysis shows that 80% of trusts use the diagnostic screening guidelines developed by UKST and approved by NICE and 100% employ its recommended treatment pathway and though improved hospital performance is inferred, there are still about 250,000 cases of sepsis each year in the UK resulting in over 50,000 deaths. 

So why does the one-hour target get missed?  All acute hospitals and GP practices have clinical guidelines to assist patient management although, assuring quality and achieving compliance is easier said than done – and for perfectly legitimate reasons.  The key is spotting at risk patients and detecting the onset of sepsis although, detection and speedy treatment are bedevilled by the sheer rapidity with which it might proceed to lethality.  Targets will be missed because test results are delayed and the most appropriate antibiotic may take time to determine.  Nevertheless, since hospitals have had money withheld for missing the one-hour target incremental advances are evident. 

Superficially, we seem to be seeing an increase in the occurrence of sepsis.  But one asks might this be just a statistical artefact?  The nature of hospital death certification and the coding of patient records is far more serendipitous than most imagine and make it very difficult to keep track on actual deaths from sepsis.  Its diagnosis is fashionable and it thus attracts attention in the records.  Yet, it is perfectly common for someone to die of sepsis with multiple organ failure, but the death be recorded as the specific cause, say due to pneumonia, thus skewing the true incidence. 

Whether or not there is more sepsis about is not the issue.  The concern for policymakers and clinicians is certainly that this should be made more measurable, but most essentially, its pernicious nature should make looking out for it the business of everyone – including the ward cleaner!”