A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK

Frankling, Catriona; Patel, Jaimin; Sharif, Ben; Melody, Teresa; Yeung, Joyce; Gao, Fang; Szakmány, Tamás

doi:10.5005/jp-journals-10071-23204

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…With respect to compliance with SSCB, recent studies have indicated that very few patients received all the six interventions of the bundle within the recommended 1 h and the elements were not consistently applied [11]. This is in line with our findings.…”

Section: Discussionsupporting

confidence: 91%

“…The Sepsis Six Care Bundle (SSCB) was recently introduced into the maternity hospitals of the health region under examination in this study, in the form of a sticker on patients' notes, with the aim of delivering all six elements of the bundle (Additional file 1: Sepsis Six Sticker) within 1 h of sepsis being provisionally diagnosed. However, compliance has not been uniform and in line with the suggestions of SSCB [11].…”

Section: Introductionmentioning

confidence: 84%

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Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals

Abutheraa

Grant

Mullen

2021

BMC Pregnancy Childbirth

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Background This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying sepsis by comparing them with positive culture. This study also sought to evaluate compliance with using the Sepsis Six Care Bundle (SSCB) operated in an individual health board. Methods A retrospective cohort study was conducted in 3 maternity hospitals of a single Scottish health board that admitted 2690 pregnancies in a 12 weeks period in 2016. Data for study was obtained from medical notes, handheld and electronic health records for women who were prescribed antibiotics with a confirmed or suspected diagnosis of sepsis. Data on clinical parameters was used to classify women according to mSIRS, qSOFA and MEWS as having sepsis or not and this was compared to results of positive culture to obtain sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under Receiver Operating Characteristic curve (AUROC) along with their 95% confidence intervals. Data was also obtained on SSCB compliance. Results A total of 89 women were diagnosed with sepsis, of which 14 had missing data, leaving 75 for final analysis. Sensitivity, specificity, PPV, NPV and AUROC of mSIRS and MEWS were almost similar with AUROC of both being around 50%. Only 33 (37.1%) had identifiable sepsis six sticker displayed on medical notes and only 2 (2.2%) had all elements of SSCB delivered within the recommended one-hour post-diagnosis period. Blood culture and full blood count with other lab tests had been performed for most women (97%) followed by intravenous antibiotics and fluids (93.9%). Conclusions mSIRS and MEWS were quite similar in detecting sepsis when compared to positive culture, with their ability to detect sepsis being close to chance. This underlines the need for creating a valid SSS with high sensitivity and specificity for clinical use in obstetric settings. Clinical use of SSCB was limited despite it being a health board policy, although there is considerable possibility of improvement following detailed audits and removal of barriers for implementing SSCB.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 84%

Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals

Abutheraa

Grant

Mullen

2021

BMC Pregnancy Childbirth

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“…To facilitate linkage to national databases for the collection of follow-up data, we collected patient-identifiable data and entered it on to the secure data collection tool 19 . Further description of the methodology and performance of this platform is outlined in previous publications 16 , 18 – 23 .…”

Section: Methodsmentioning

confidence: 99%

“…Although high-profile cases and systematic campaign from advocacy groups helped to increase awareness of the condition in the last decade, there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK 15 , 16 . While the use of sepsis screening tools and the delivery of the ‘Sepsis Six’ bundle is now a key performance indicator in many institutions, external scrutiny of such initiatives is lacking 17 , 18 . The aim of our study was to examine the changes in care processes and outcomes over a four-year period, by utilising our yearly All Wales point-prevalence study on sepsis.…”

Section: Introductionmentioning

confidence: 99%

Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

Kopczynska

Unwin

Pugh

et al. 2021

Sci Rep

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The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.

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“…One of the most easily measured parameters is lactate. Measurement of lactate levels is still recommended by the Sepsis Six approach, initially developed in 2009 but still applied in recent years [19,20]. Sepsis Six is also an initial bundle that contributes to timely care including the administration of crystalloids, oxygen, antibiotics in the first hour along with microbiological sampling, measurement of urine output and lactate levels.…”

Section: Introductionmentioning

confidence: 99%

Differentiating sepsis from similar groups of symptoms at triage level in emergency care

Molnár

Gyarmathy

Takács

et al. 2021

PhysInt

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ObjectivesConditions that have similar initial presentations as sepsis may make early recognition of sepsis in an emergency room (ER) difficult. We investigated whether selected physiologic and metabolic parameters can be reliably used in the emergency department to differentiate sepsis from other disease states that mimic it, such as dehydration and stroke.MethodsLoess regression on retrospective follow-up chart data of patients with sepsis-like symptoms (N = 664) aged 18+ in a large ER in Hungary was used to visualize/identify cutoff points for sepsis risk. A multivariate logistic regression model based on standard triage data was constructed with its corresponding receiver operating characteristic (ROC) curve and compared with another model constructed based on current sepsis guidelines.ResultsAge, bicarbonate, HR, lactate, pH, and body temperature had U, V, W, or reverse U-shaped associations with identifiable inflexion points, but the cutoff values we identified were slightly different from guideline cutoff values. In contrast to the guidelines, no inflexion points could be observed for the association of sepsis with SBP, DPB, MAP, and RR and therefore were treated as continuous variables. Compared to the guidelines-based model, the triage data-driven final model contained additional variables (age, pH, bicarbonate) and did not include lactate. The data-driven model identified about 85% of sepsis cases correctly, while the guidelines-based model identified only about 70% of sepsis cases correctly.ConclusionOur findings contribute to the growing body of evidence for the necessity of finding improved tools to identify sepsis at early time points, such as in the ER.

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A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK

Cited by 10 publications

References 29 publications

Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals

Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals

Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

Differentiating sepsis from similar groups of symptoms at triage level in emergency care

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