11 September 2017

The Shrewsbury and Telford Hospital NHS Trust (SaTH) is making significant improvements in the screening and treatment of patients with Sepsis.

Sepsis arises when the body’s response to an infection injures the person’s own tissues and organs. It leads to shock, multiple organ failure and death, especially if not recognised early and treated promptly. There are around 150,000 cases of Sepsis in the UK every year and approximately 44,000 deaths.

The Shrewsbury and Telford Hospital NHS Trust (SaTH) has been working to improve care for patients who suffer Sepsis by using techniques learned from the Virginia Mason Institute (VMI) in Seattle, as part of a five-year partnership.

Recent media coverage has suggested that SaTH has a relatively low percentage of patients being treated with antibiotics for Sepsis within the so-called “golden hour”.

Whilst the Trust does not dispute the data used in the report, the figures come from a random sample of patients used for the National CQUIN required by NHS England which can lead to anomalies if there are shortcomings in documentation.  The figures cover the 12 months up to March this year.

The most recent figures, for the first quarter of 2017/18, show a Trust overall  figure of 67% of patients received antibiotics within an hour of being diagnosed.  Amongst In-patients, this figure rose to 86%.

As part of its improvement work with VMI, SaTH has been trialling improvements on the Acute Medical Unit at the Princess Royal Hospital in Telford and the Emergency Department, Surgical Assessment Unit, Ward 28 and the Laboratories at the Royal Shrewsbury Hospital.

When we carry out the measurements for this work, we look at all of the patients and their pathways in these areas, which provides a greater level of detail.

This work is now being rolled out to other acute areas, such as the Acute Medical Unit and intensive Care Unit at RSH and the Emergency Department at PRH.

Dr Edwin Borman, Medical Director at The Shrewsbury and Telford Hospital NHS Trust (SaTH), said: “While we are making improvements to improve our documentation, what we are really focusing on is making improvements in clinical care, which will in turn improve outcomes for our patients.”

Improvements made at SaTH include:

  • Improving recognition of the symptoms of sepsis, through a staff training module and advanced recognition training for reception teams in our emergency areas
  • Improving screening of patients with potential sepsis
  • Reducing time in diagnosing sepsis and starting treatment
  • Reducing the time to give a patient all the elements of the “Sepsis Six” bundle of treatment
  • Reducing the turn-around time in the laboratory for these urgent specimens
  • The development of a sepsis trolley so that patients can be treated more rapidly
  • An online learning booklet for staff to improve their knowledge of sepsis

Dr Borman said: “Many NHS organisations have challenges managing sepsis, and we identified that it was important to address them within our Trust, firstly by raising the profile of sepsis to improve awareness. The UK Sepsis Trust and others have been doing great work in this area, but we knew there was more we could be doing in SaTH.

“Since then, we have been developing improvements on some of our wards, many of which are exceeding initial expectations. We have made changes to all elements of the sepsis pathway, including reducing the time taken to deliver the sepsis bundle to under 30 minutes on these wards.

“There have also been important reductions in the time taken to recognise and confirm sepsis, giving people the best chance of fast treatment. This includes a 60% reduction in the time taken to obtain initial diagnosis and a reduction in the time it takes to turn round the blood sample. Treatment is also much quicker now, with the average time for delivery of antibiotics now 83% faster than before the improvements were made.

“We will now be looking to roll out the learning from these wards to all wards in our hospitals.

“We know that we have to improve on our documentation, but our primary focus has been on making improvements for our patients.

“We shall be welcoming Dr Ron Daniels, CEO of the UK Sepsis Trust, to SaTH later this month for a shared learning event, not only for our Consultants and Nurses, but also for colleagues from Community Health and GPs. This will promote the importance of recognising and treating Sepsis. We look forward to discussing with Dr Daniels our progress in this area and sharing ideas on how we can further improve.”